ENDOCUT Q coagulation fraction is associated with esophageal stricture after endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) carries a substantial risk of esophageal stricture formation. We aimed to quantify the coagulation component embedded within ENDOCUT Q mode using a custom-developed energy sensor and to investigate its association with post-ESD esophageal stricture.

Patients who underwent ESD for early esophageal cancer between 2021 and 2024 were retrospectively reviewed. A custom energy sensor was used to measure real-time electrosurgical output, allowing separate quantification of cutting and coagulation energy in ENDOCUT Q mode. The ENDOCUT Q coagulation fraction (ECF) was defined as the proportion of coagulation energy within total ENDOCUT Q energy. For exploratory categorical analyses, ECF was classified as low (< 1%), medium (1-10%), or high (> 10%) using cohort-derived thresholds. Independent factors associated with post-ESD esophageal stricture were identified using multivariable logistic regression.

Among 681 patients, post-ESD stricture occurred in 124 patients (18.2%). In multivariable analysis, circumferential extent > 3/4 (odds ratio [OR] 10.91, 95% confidence interval [CI] 4.94-24.11, p < 0.001), FORCED COAG energy density ≥ 22.02 J/cm² (OR 3.55, 95% CI 2.03-6.19, p < 0.001), and high ECF (OR 3.03, 95% CI 1.18-7.81, p = 0.022) were independently associated with post-ESD stricture. In an exploratory analysis among patients with circumferential extent > 3/4 who developed stricture, high ECF was also associated with refractory esophageal stricture.

ECF was independently associated with post-ESD esophageal stricture. These findings suggest that coagulation-related thermal exposure may be associated with stricture formation and that ECF may serve as a potential quantifiable procedure-level marker of electrosurgical exposure.