High total Joule heat increases the risk of post-endoscopic submucosal dissection electrocoagulation syndrome after colorectal endoscopic submucosal dissection

作     者：Masanori Ochi Ryosuke Kawagoe Toshiro Kamoshida Yukako Hamano Haruka Ohkawara Atsushi Ohkawara Nobushige Kakinoki Yuji Yamaguchi Shinji Hirai Akinori Yanaka Kiichiro Tsuchiya 

作者机构：Department of GastroenterologyHitachi General HospitalHitachi City 317-0077IbarakiJapan Department of GastroenterologyFaculty of MedicineUniversity of TsukubaTsukuba 305-8576IbarakiJapan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2021年第27卷第38期

页      面：6442-6452页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Post-endoscopic submucosal dissection electrocoagulation syndrome Joule heat Colorectal endoscopic submucosal dissection Colorectal neoplasms Electrocoagulation Gastrointestinal tract 

摘      要：BACKGROUND We hypothesized that thermal damage accumulation during endoscopic submucosal dissection(ESD)causes the pathogenesis of post-ESD electrocoagulation syndrome(PECS).AIM To determine the association between Joule heat and the onset of PECS.METHODS We performed a retrospective cohort study in patients who underwent colorectal ESD from May 2013 to March 2021 in Japan.We developed a novel device that measures 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≥10000μ/L).Patients exposed to more or less than the median Joule heat value were assigned to the high and low Joule heat groups,respectively.Statistical analyses included Mann-Whitney U and chisquare tests and logistic regression and receiver operating characteristic curve(ROC)analyses.RESULTS 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)].CONCLUSION Joule heat accumulation in the gastrointestinal wall is involved in the onset of PECS.ESD-related thermal damage to the peeled mucosal surface is probably a major component of the mechanism underlying PECS.