High Joule heat as a risk factor for post-endoscopic submucosal dissection electrocoagulation syndrome: A multicenter prospective study

Background: Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection (ESD).

Aim: To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome (PECS).

Methods: 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.

Results: 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, P < 0.01). The procedure time and presence of lesions in the right colon were not associated with PECS.

Conclusion: 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.