Background and study aims: The risk of post endoscopic submucosal dissection electrocoagulation syndrome (PEECS)
is unknown. We aimed to investigate the incidence and clinicopathologic risk factors
associated with PEECS after colorectal endoscopic submucosal dissection (ESD).
Patients and methods: All patients treated with colorectal ESD between 2009 and 2011 by a single expert
ESD endoscopist at Gangnam Severance Hospital, Seoul, Korea were included in this
retrospective study. Patients who had fever, regional rebound tenderness, or marked
leukocytosis after ESD were defined as having PEECS.
Results: 89 patients were treated during the study period. Six patients with microperforation
and one patient with overt perforation were excluded. Thus, 82 cases without perforation
were analyzed. The risk of PEECS was 40.2 %. In the PEECS group, the mean size of
resected specimens was larger and mean procedure time was longer than in the patients
without PEECS. The risk of PEECS was significantly lower for patients with carcinoid
tumors, and for ESD in the rectosigmoid area. Piecemeal resection was significantly
associated with the development of PEECS. In multivariate analysis, lesion size larger
than 3 cm (odds ratio [OR] 5.0, 95 % confidence interval [95 %CI] 1.2 – 21.7) and
site other than rectosigmoid (OR 7.6, 95 %CI 2.1 – 27.9) were independent risk factors
for PEECS.
Conclusions: Large tumor size and tumor site other than rectosigmoid were independent risk factors
related to PEECS. Patients with tumors larger than 3 cm, in colon areas other than
the rectosigmoid, should be observed carefully after colorectal ESD.
