Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2021; 27(38): 6442-6452
Published online Oct 14, 2021. doi: 10.3748/wjg.v27.i38.6442
High total Joule heat increases the risk of post-endoscopic submucosal dissection electrocoagulation syndrome after colorectal endoscopic submucosal dissection
Masanori Ochi, Ryosuke Kawagoe, Toshiro Kamoshida, Yukako Hamano, Haruka Ohkawara, Atsushi Ohkawara, Nobushige Kakinoki, Yuji Yamaguchi, Shinji Hirai, Akinori Yanaka, Kiichiro Tsuchiya
Masanori Ochi, Toshiro Kamoshida, Yukako Hamano, Haruka Ohkawara, Atsushi Ohkawara, Nobushige Kakinoki, Yuji Yamaguchi, Shinji Hirai, Department of Gastroenterology, Hitachi General Hospital, Hitachi City 317-0077, Ibaraki, Japan
Ryosuke Kawagoe, Akinori Yanaka, Kiichiro Tsuchiya, Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan
Author contributions: Ochi M, Kawagoe R, Kamoshida T, Hamano Y, Ohkawara A, Ohkawara H, Kakinoki N, Yamaguchi Y, Hirai S, Yanaka A and Tsuchiya K contributed equally to this work; Ochi M and Kawagoe R collected and analyzed the data; Ochi M and Kawagoe R drafted the manuscript; Ochi M, Kawagoe R and Kamoshida T designed and supervised the study; Hamano Y, Ohkawara A, Ohkawara H, Kakinoki N, Yamaguchi Y, Hirai S, Yanaka A and Tsuchiya K offered technical or material support; all authors have read and approved the final version to be published.
Institutional review board statement: The Hitachi General Hospital Institutional Review Board approved this study (2019-97, 2020-1), and it was performed according to the ethical guidelines of the 1964 Declaration of Helsinki and its later amendments.
Informed consent statement: Informed consent was obtained using an opt-out option on the Hitachi General Hospital’s website (see institution website uniform resource locators: http://www.hitachi.co.jp/hospital/hitachi/infor/opto-out/index.html).
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at maochi-tei@umin.ac.jp.
STROBE statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised according to the STROBE Statement -checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masanori Ochi, MD, Doctor, Department of Gastroenterology, Hitachi General Hospital, 2-1-1, Jonancho, Hitachi City, Hitachi City 317-0077, Ibaraki, Japan. maochi-tei@umin.ac.jp
Received: May 24, 2021
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
Processing time: 140 Days and 17.7 Hours
Abstract
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 ≥ 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. Statistical analyses included Mann-Whitney U and chi-square 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.

Keywords: Post-endoscopic submucosal dissection electrocoagulation syndrome; Joule heat; Colorectal endoscopic submucosal dissection; Colorectal neoplasms; Electrocoagulation; Gastrointestinal tract

Core Tip: We investigated the association between Joule heat and the onset of post- endoscopic submucosal dissection electrocoagulation syndrome (PECS), using originally developed a device to measure swift coagulation time with a sensor adjacent to the electrosurgical coagulation unit foot switch which enabled us to calculate total Joule heat. High Joule heat was an independent PECS risk factor. Moreover, the area under the operating characteristic curve showing the correlation between PECS and total Joule heat was high. Joule heat accumulation is involved in the onset of PECS. endoscopic submucosal dissection-related thermal damage of the peeled mucosal surface is probably a major component of the mechanism underlying PECS.