Prospective cross-organ analysis for the causes of fever and increased inflammatory response after endoscopic resection
Mari Mizutani
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorDaisuke Minesaki
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorKohei Morioka
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorKentaro Iwata
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorKurato Miyazaki
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorTeppei Masunaga
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorYoko Kubosawa
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorYukie Hayashi
Center for Preventive Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorMotoki Sasaki
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorTeppei Akimoto
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorYusaku Takatori
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorNoriko Matsuura
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorAtsushi Nakayama
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorTomohisa Sujino
Center for Diagnostic and Therapeutic Endoscopy, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorKaoru Takabayashi
Center for Diagnostic and Therapeutic Endoscopy, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorTakanori Kanai
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorNaohisa Yahagi
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Motohiko Kato
Center for Diagnostic and Therapeutic Endoscopy, Keio University, School of Medicine, Tokyo, Japan
Corresponding: Motohiko Kato, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Email: [email protected]
Search for more papers by this authorMari Mizutani
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorDaisuke Minesaki
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorKohei Morioka
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorKentaro Iwata
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorKurato Miyazaki
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorTeppei Masunaga
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorYoko Kubosawa
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorYukie Hayashi
Center for Preventive Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorMotoki Sasaki
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorTeppei Akimoto
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorYusaku Takatori
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorNoriko Matsuura
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorAtsushi Nakayama
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorTomohisa Sujino
Center for Diagnostic and Therapeutic Endoscopy, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorKaoru Takabayashi
Center for Diagnostic and Therapeutic Endoscopy, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorTakanori Kanai
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorNaohisa Yahagi
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Motohiko Kato
Center for Diagnostic and Therapeutic Endoscopy, Keio University, School of Medicine, Tokyo, Japan
Corresponding: Motohiko Kato, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Email: [email protected]
Search for more papers by this authorTrial registration: This study was registered with the University Hospital Medical Information Network (UMIN); 000039052.
Abstract
Objectives
Fever and increased inflammatory responses sometimes occur following endoscopic resection (ER). However, the differences in causes according to the organ are scarcely understood, and several modified ER techniques have been proposed. Therefore, we conducted a comprehensive prospective study to investigate the cause of fever and increased inflammatory response across multiple organs after ER.
Methods
We included patients who underwent gastrointestinal endoscopic submucosal dissection (ESD) and duodenal endoscopic mucosal resection at our hospital between January 2020 and April 2022. Primary endpoints were fever and increased C-reactive protein (CRP) levels following ER. The secondary endpoints were risk factors for aspiration pneumonia. Blood tests and radiography were performed on the day after ER, and computed tomography was performed if the cause was unknown.
Results
Among the 822 patients included, aspiration pneumonia was the most common cause of fever and increased CRP levels after ER of the upper gastrointestinal tract (esophagus, 53%; stomach, 48%; and duodenum, 71%). Post-ER coagulation syndrome was most common after colorectal ESD (38%). On multivariate logistic regression analysis, lesions located in the esophagus (odds ratio [OR] 3.57; P < 0.001) and an amount of irrigation liquid of ≥1 L (OR 3.71; P = 0.003) were independent risk factors for aspiration pneumonia.
Conclusions
Aspiration pneumonia was the most common cause of fever after upper gastrointestinal ER and post-ER coagulation syndrome following colorectal ESD. Lesions in the esophagus and an amount of irrigation liquid of ≥1 L were independent risk factors for aspiration pneumonia.
CONFLICT OF INTEREST
Author M.K. has received honoraria from the companies Olympus, Fujifilm, and Takeda pharmaceuticals for lectures.
Supporting Information
| Filename | Description |
|---|---|
| den14740-sup-0001-FigureS1.pdfPDF document, 267.9 KB | Figure S1 Changes in CRP before and after endoscopic resection: a. no adverse events, b. aspiration pneumonia, c. post-ER coagulation syndrome, d. delayed perforation. CRP, C-reactive protein; PECS, post endoscopic submucosal resection coagulation syndrome; post-ER, post-endoscopic submucosal resection; Pre-ER, pre-endoscopic submucosal resection. |
| den14740-sup-0002-FigureS2.pdfPDF document, 74.7 KB | Figure S2 Association between NLR and adverse events. NLR, neutrophil-lymphocyte ratio; PECS, post endoscopic submucosal resection coagulation syndrome. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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