Fever and electrocoagulation syndrome after colorectal endoscopic submucosal dissection for patients with immunosuppressants and steroids

Abstract

Objectives Transient fever and electrocoagulation syndrome after colorectal endoscopic submucosal dissection (ESD) remain a challenge. The aim of this study was to assess the risk factors of post‐ESD fever and post‐ESD coagulation syndrome (PECS), focusing on the involvement of immunosuppressive drugs and steroids (IM). Methods This retrospective analysis included 510 patients who underwent colorectal ESD at Okayama University Hospital from 2015 to 2020. The incidence rate, clinical outcome, and factors associated with post‐ESD fever and PECS were investigated. Results Post‐ESD fever and PECS occurred in 63 patients (12.4%) and 43 patients (8.4%), respectively. In multivariate analysis, the American Society of Anesthesiologists Physical Status ≥3, the use of immunosuppressants or prednisolone ≥5mg (IM group), and injury to muscle layer/perforation were significantly associated with post‐ESD fever. In PECS, IM group, tumors located on the right side, treatment time ≥60 min, injury to the muscle layer, and multiple lesions were independent risk factors. Both post‐ESD fever and PECS improved conservatively in the IM group, and no serious complication was observed. Conclusions The use of IM was a risk factor for both post‐ESD fever and PECS. However, there were no serious complications in colorectal ESD for patients taking IM.

Injury to the muscle layer, increasing the risk of post‐colorectal endoscopic submucosal dissection electrocoagulation syndrome

“…They speculated that the wall of the cecum was so stretchable that heat after electrocoagulation would extend more easily to the muscularis propria. In addition, other studies reported that female sex, 9,27–29 submucosal fibrosis, 10,27 and long procedure time 8,17,28 and the use of immunosuppressants or steroid 17 were risk factors for PECS in colorectal ESD. Of note, female sex was commonly identified as an independent risk factor for PECS in many studies.…”

“…In our study, female sex was also identified as a risk factor for PECS in addition to long procedure time and large specimen size. Yamamoto et al 17 reported that injury to the muscle layer was an independent risk factor for PECS after colorectal ESD. However, there was no clear definition of injury to the muscle layer, and the relationship between the grade of the injury to the muscle layer and PECS was not assessed.…”

“…reported the risk factors for PECS in colorectal ESD for the first time that a tumor size over 30 mm and a location other than the rectosigmoid were independent risk factors for PECS 6 . Other studies also identified large resected specimens 9,13 and tumor locations (cecum and ascending colon) 9,17,27,28 as independent risks for PECS in colorectal ESD. In particular, Arimoto et al ., 28 in a prospective multicenter observational study, reported tumors located in the cecum as having a high OR of PECS (OR 20.6, 95% CI: 3.7–115.2).…”

“…[14][15][16] Yamaguchi et al reported that muscle layer exposure is an independent risk factor for PECS and mediastinal emphysema in esophageal ESD. 16 Yamamoto et al 17 reported that injury to the muscle layer was an independent risk factor for transient fever and PECS after colorectal ESD. However, there are no reports on the association between the grade of muscle layer injury and PECS.…”

“…reported that muscle layer exposure is an independent risk factor for PECS and mediastinal emphysema in esophageal ESD 16 . Yamamoto et al 17 . reported that injury to the muscle layer was an independent risk factor for transient fever and PECS after colorectal ESD.…”