Risk Factors And Causes Of Fever After Endoscopic Submucosal Dissection Of Gastrointestinal Tumors

Objective:This study is to research the risk factors and causes of fever after endoscopic submucosal dissection (ESD) of gastrointestinal tumors, and to explore the relationship between the highest body temperature within 24 hours(Tmax) after ESD and the postoperative complications of ESDMethods:A retrospective study was performed on 100 cases of ESD in our hospital from December 2012 to December 2015. A total of 98 patients met the inclusion criteria in the study. Based on whether they had postoperative fever (T≥38℃), the patients were divided into two groups. The basic characteristics, postoperative complications, operation time, postoperation hospitalization and cost of hospitalization were compared between two groups. This study is to analyze the risk factors and causes of postoperative fever after ESD, to research the correlation between Tmax after ESD and postoperative complications, and the predictive value of Tmax after ESD in the postoperative complications of ESD by the receiver operating characteristic(ROC) curves.Results:Between the fever group (n=33) and no fever group (n=65), we found no significant difference in basic characteristics (gender, age, body mass index), gross type, postoperative hospitalization and treatment cost. The percentage of Patients with fever after gastric ESD 21.2% was significantly lower than the esophagus and colon ESD 59.4%(P< 0.05). The operation time was longer in fever group 124 min (35-390 min) than in no fever group 86 min(36-260 min) (P< 0.05).The resected specimen size was larger in fever group 4.0 cm (1.2±10.0 cm) than in no fever group 1.9 cm(1.0-6.5 cm) (P< 0.05). The complication rate was higher in fever group 39.4% than in no fever group 4.6%(P< 0.05). Using the multivariate logistic regression, we found that the resected specimen size (OR:1.797,95%CI:1.174-2.750, P< 0.05) was an independent risk factor for postoperative fever after ESD. In patients without pneumonia, the resected specimen size (OR:1.725,95%CI:1.118-2.660, P< 0.05) was still an independent risk factor for postoperative fever in patients after ESD. By Spearman correlation analysis, we found that Tmax after ESD significantly related to pneumonia, antibiotic use, and fasting time (P< 0.05). The area under the ROC curve (AUC) of the resected specimen size for ESD postoperative fever was 0.786. Setting the cutoff value of 2.70cm, the sensitivity was 72.7% and the specificity was 73.8%.The AUC of Tmax after ESD for postoperative complications of ESD was 0.845. Setting the cutoff value of 37.95 "C, the sensitivity was 86.7% and the specificity was 75.9%.Conclusion:The ESD resected specimen size is an independent risk factors for fever after ESD. Patients need to be paid more attention in case of postoperative fever when the resected specimen size was larger then 2.70cm. Tmax after ESD can be a predictor of postoperative complications of ESD, Physicians should pay more attention to patients whose Tmax after ESD was higher than or equal to 38℃.