Water cooling to prevent electrocoagulation syndrome after endoscopic resection of colorectal neoplasm

With the increasing frequency of electrocoagulation hemostasis used in endoscopic submucosal dissection (ESD), the incidence of postoperative bleeding is gradually decreasing, while the incidence of post-ESD electrocoagulation syndrome (PECS) is gradually increasing. Water cooling can reduce thermal injury to the intestinal wall after electrocoagulation. Therefore, this study intends to conduct a prospective, multi-center randomized controlled trial to explore the effectiveness of water cooling after electrocoagulation in reducing the occurrence of PECS.

From November 2022 to October 2023, 420 patients were prospectively included. The patients were 1:1 randomly divided into two groups, named the standard ESD (S-ESD) group and the water-cooled ESD (W-ESD) group. The main outcome measure was the incidence of PECS. Secondary outcomes were ESD operative time, complete resection rates, and adverse effects.

The incidence of PECS in the W-ESD group was significantly lower than that in the S-ESD group (7.6% vs. 17.1%, P = 0.003). The median operation time was also shorter in the W-ESD group than in the S-ESD group (37.0 minutes, IQR: 30.0-47.0 minutes vs 42.5 minutes, IQR: 33.0-60.0 minutes, P < 0.001). There was no significant difference in specimen size between the two groups (3.8cm2, IQR: 3.1-6.3cm2 vs 4.6cm2, IQR: 3.1-7.1cm2, P = 0.286), and the complete resection rate was 100%. No perforation occurred in any patient.

Water-cooled ESD technology can significantly reduce the occurrence of PECS.