Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea.
World J Gastroenterol. 2018 Mar 14;24(10):1144-1151. doi: 10.3748/wjg.v24.i10.1144.
To investigate post endoscopic submucosal dissection electrocoagulation syndrome (PEECS) of the esophagus.
We analyzed 55 consecutive cases with esophageal endoscopic submucosal dissection for superficial esophageal squamous neoplasms at a tertiary referral hospital in South Korea. Esophageal PEECS was defined as "mild" meeting one of the following criteria without any obvious perforation: fever (≥ 37.8 °C), leukocytosis (> 10800 cells/μL), or regional chest pain more than 5/10 points as rated on a numeric pain intensity scale. The grade of PEECS was determined as "severe" when meet two or more of above criteria.
We included 51 cases without obvious complications in the analysis. The incidence of mild and severe esophageal PEECS was 47.1% and 17.6%, respectively. Risk factor analysis revealed that resected area, procedure time, and muscle layer exposure were significantly associated with PEECS. In multivariate analysis, a resected area larger than 6.0 cm (OR = 4.995, 95%CI: 1.110-22.489, = 0.036) and muscle layer exposure (OR = 5.661, 95%CI: 1.422-22.534, = 0.014) were independent predictors of esophageal PEECS. All patients with PEECS had favorable outcomes with conservative management approaches, such as intravenous hydration or antibiotics.
Clinicians should consider the possibility of esophageal PEECS when the resected area exceeds 6.0 cm or when the muscle layer exposure is noted.
研究内镜黏膜下剥离术后电凝综合征（PEECS）的食管表现。
我们分析了韩国一家三级转诊医院的 55 例连续接受内镜下黏膜剥离术治疗浅表性食管鳞状上皮内肿瘤的患者。食管 PEECS 定义为“轻度”，符合以下标准之一，且无明显穿孔：发热（≥37.8°C）、白细胞增多（>10800 个/μL）或数字疼痛强度量表评分超过 5/10 的区域性胸痛。如果符合上述标准中的两个或更多标准，则将 PEECS 分级为“重度”。
我们将 51 例无明显并发症的患者纳入分析。轻度和重度食管 PEECS 的发生率分别为 47.1%和 17.6%。危险因素分析显示，切除面积、手术时间和肌层暴露与 PEECS 显著相关。多变量分析显示，切除面积大于 6.0 cm（OR=4.995，95%CI：1.110-22.489，P=0.036）和肌层暴露（OR=5.661，95%CI：1.422-22.534，P=0.014）是食管 PEECS 的独立预测因素。所有 PEECS 患者均通过静脉补液或抗生素等保守治疗方法获得良好结局。
当切除面积超过 6.0 cm 或肌层暴露时，临床医生应考虑发生食管 PEECS 的可能性。
