Published online Oct 14, 2021. doi: 10.3748/wjg.v27.i38.6442
Peer-review started: May 24, 2021
First decision: June 22, 2021
Revised: July 17, 2021
Accepted: September 10, 2021
Article in press: September 10, 2021
Published online: October 14, 2021
Few studies have examined the impact of endoscopic submucosal dissection (ESD)-related thermal damage on the onset of post-ESD electrocoagulation syndrome (PECS).
We hypothesized that electrocoagulation is associated with Joule heat capable of causing thermal damage to the gastrointestinal wall during long ESD operations.
We aimed to determine the association between high Joule heat and the onset of PECS.
We developed a novel device to measure the swift coagulation time with a sensor adjacent to the electrosurgical coagulation unit foot switch, which enabled us to calculate total Joule heat. PECS was defined as localized abdominal pain (visual analogue scale ≥ 30 mm during hospitalization or increased by ≥ 20 mm from the baseline) and fever (temperature ≥ 37.5 degrees or white blood cell count ≥ 10000 µ/L). Patients exposed to more or less than the median Joule heat value were assigned to the high and low Joule heat groups, respectively.
We evaluated 151 patients. The PECS incidence was 10.6% (16/151 cases), and all patients were followed conservatively and discharged without severe complications. In multivariate analysis, high Joule heat was an independent PECS risk factor. The area under the ROC curve showing the correlation between PECS and total Joule heat was high [0.788 (95% confidence interval: 0.666-0.909)].
Joule heat accumulation in the gastrointestinal wall is involved in the onset of PECS. ESD-related thermal damage of the peeled mucosal surface is probably a major component of the mechanism underlying PECS.
Future prospective studies should be performed to establish the validity of our results.