Ochi Masanori, Yamamoto Asaji, Suematsu Satoshi, Fukuda Keita, Morishige Kenjiro, Oka Yasuhiro, Ishikawa Yuta, Ueyama Shunsuke, Hiroshima Yoshinori, Omae Yoshio, Kusano Fumihiko, Kamoshida Toshiro
Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan.
Department of Gastroenterology, Institute of Medicine, University of Tsukuba, Tsukuba 305-8576, Japan.
World J Gastrointest Endosc. 2024 Dec 16;16(12):668-677. doi: 10.4253/wjge.v16.i12.668.
Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection (ESD).
To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome (PECS).
In this prospective study, PECS was characterized by in-hospital fever (white blood cell count: ≥ 10000 μ/L or body temperature ≥ 37.5 °C) and abdominal pain (visual analog scale score ≥ 30 mm during hospitalization or increased by ≥ 20 mm from baseline at admission). High Joule heat was defined as 15390 J. Between April 2020 and April 2024, 209 patients underwent colorectal ESD; those with intraoperative perforation or penetration were excluded. The remaining 202 patients were divided into the PECS and non-PECS groups.
PECS occurred in 30 (14.9%) patients. Multivariate analysis revealed high Joule heat as an independent factor associated with PECS (odds ratio = 7.96; 95% confidence interval: 2.91-21.8, < 0.01). The procedure time and presence of lesions in the right colon were not associated with PECS.
Accumulated thermal damage on the peeled mucosal surface should be considered during PECS onset. This thermal damage is likely a major component of the mechanism underlying PECS.
热损伤可能在内镜黏膜下剥离术（ESD）期间导致剥脱黏膜表面发生炎症。
确定焦耳热对ESD后电凝综合征（PECS）发病的影响。
在这项前瞻性研究中，PECS的特征为住院期间发热（白细胞计数：≥10000μ/L或体温≥37.5°C）和腹痛（住院期间视觉模拟评分≥30mm或入院时较基线增加≥20mm）。高焦耳热定义为15390焦耳。在2020年4月至2024年4月期间，209例患者接受了结直肠ESD；排除术中穿孔或穿透的患者。其余202例患者分为PECS组和非PECS组。
30例（14.9%）患者发生PECS。多因素分析显示高焦耳热是与PECS相关的独立因素（比值比=7.96；95%置信区间：2.91-21.8，P<0.01）。手术时间和右半结肠病变的存在与PECS无关。
在PECS发病过程中应考虑剥脱黏膜表面累积热损伤。这种热损伤可能是PECS潜在机制的主要组成部分。
