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

Table 1 Baseline characteristics of eligible patients

Patient features
Number of patients	202
Male, n (%)	147 (72.8)
Age (years), mean ± SD	69.9 ± 10.1
BMI (kg/m2), mean ± SD	23.7 ± 3.6
Specimen size (mm), mean ± SD	31.7 ± 12.8
Tumor location, n (%)
Right colon	81 (40.1)
Left colon	61 (30.2)
Rectum	60 (29.7)
Tumor morphology, n (%)
0-Is/Ip	88 (43.6)
LST-G	97 (48.0)
LST-NG (0-IIc)	17 (8.4)
ECOG performance status after ESD, n (%)
0	194 (96.0)
≥ 1	8 (4.0)

BMI: Body mass index; Is: Sessile type; Ip: Pedunculated type; LST-G: Lateral spreading tumor granular type; LST-NG: Lateral spreading tumor non-granular type; IIc: Superficial depressed type; ECOG: Eastern Cooperative Oncology Group; ESD: Endoscopic submucosal dissection.

Table 2 Clinicopathological factors in the post-endoscopic submucosal dissection electrocoagulation syndrome and non-post-endoscopic submucosal dissection electrocoagulation syndrome groups

	PECS group, n = 30	Non-PECS group, n = 172	P value		OR (95%CI)
			Univariate analysis	Multivariate analysis
Sex, n (%)			0.52
Male	21 (70.0)	126 (73.3)
Female	9 (30.0)	46 (26.7)
Age, n (%)			0.54
< 75 years	17 (56.7)	112 (65.1)
≥ 75 years	13 (43.3)	60 (34.9)
Specimen size, n (%)			0.24
< 30 mm	11 (36.7)	83 (48.3)
≥ 30 mm	19 (63.3)	89 (48.3)
Tumor location, n (%)			1.00
Right colon	12 (40.0)	69 (40.1)
Left colon	10 (33.3)	51 (29.7)
Rectum	8 (26.7)	52 (30.2)
Tumor morphology, n (%)			0.85
0-Is/Ip	13 (43.3)	75 (43.6)
LST-G	16 (53.4)	81 (47.1)
LST-NG (0-IIc)	1 (3.3)	16 (9.3)
Depth of pathological invasion, n (%)			0.54
Tis (M)	28 (93.4)	152 (88.4)
T1a (SM < 1000 μm)	1 (3.3)	11 (6.4)
T1b (SM ≥ 1000 μm)	1 (3.3)	9 (5.2)
Endoscopist, n (%)			0.30
Experts	12 (40.0)	54 (31.4)
Trainees	18 (60.0)	118 (68.6)
Submucosal fibrosis, n (%)			0.30
Present	6 (20.0)	27 (15.7)
Absent	24 (80.0)	145 (84.3)
ESD procedure time, n (%)			0.18	0.16
< 90 minutes	11 (36.7)	91 (52.9)			1 (reference)
≥ 90 minutes	19 (63.3)	81 (47.1)			1.76 (0.80-3.86)
Total Joule heat, n (%)			< 0.01	< 0.01
Low Joule heat	4 (13.3)	105 (61.0)			1 (reference)
High Joule heat	26 (86.7)	67 (39.0)			7.96 (2.91-21.8)

PECS: Post-endoscopic submucosal dissection electrocoagulation syndrome; ESD: Endoscopic submucosal dissection; T1a (SM): Submucosal invasion depth < 1000 μm; T1b (SM): Submucosal invasion depth ≥ 1000 μm; Tis (M): Carcinoma in situ or intramucosal carcinoma; IIc: Superficial depressed type; LST-NG: Lateral spreading tumor non-granular type; LST-G: Lateral spreading tumor granular type; Ip: Pedunculated type; Is: Sessile type; OR: Odds ratio; CI: Confidence interval.

Table 3 Evaluation of the long procedure time group and short procedure time group

	Long procedure time group (≥ 90 minutes), n = 100	Short procedure time group (< 90 minutes), n = 102	P value
Sex, n (%)			0.75
Male	73 (73.0)	73 (71.6)
Female	27 (27.0)	29 (28.4)
Tumor location, n (%)			0.67
Right colon	42 (42.0)	38 (37.3)
Left colon	26 (26.0)	35 (34.3)
Rectum	32 (32.0)	29 (28.4)
ESD procedure performed by trainees, n (%)	73 (73.0)	63 (61.8)	0.10
Submucosal fibrosis, n (%)	24 (24.0)	9 (8.8)	< 0.01
PECS, n (%)	19 (19.0)	11 (10.8)	0.33

ESD: Endoscopic submucosal dissection; PECS: Post-endoscopic submucosal dissection electrocoagulation syndrome.

Table 4 Cases of adverse events in the post-endoscopic submucosal dissection electrocoagulation syndrome and non-post-endoscopic submucosal dissection electrocoagulation syndrome groups

	PECS group	Non-PECS group
Intraprocedural perforation or penetration/number of patients in each group	1/30	5/172
ESD procedure performed by trainees/number of patients in each group	1/30	5/172
Peak CRP (mg/dL), mean ± SD	4.11 ± not applicable	1.56 ± 1.42
Duration of hospitalization (days), mean ± SD	6 ± not applicable	6.2 ± 2.2

PECS: Post-endoscopic submucosal dissection electrocoagulation syndrome; ESD: Endoscopic submucosal dissection; CRP: C-reactive protein.