Risk Factors and Causes of Fever after Endoscopic Submucosal Dissection

Background: The aim of this study was to investigate the fever and related risk factors of gastrointestinal mucosa or submucosal lesions after endoscopic submucosal dissection (ESD). Methods and Results: This retrospective study included 290 patients undergoing ESD. Patients were divided into two groups according to the presence or absence of post-ESD fever. Patient-related factors and lesion-related factors were counted in both groups. The incidence of post-ESD fever was 31.0% (90/290) after the operation. Among them, 87 patients developed fever within 24 hours after the operation. Gender, smoking, hypertension, and infiltration depth of lesions were not risk factors for fever; age, diabetes, operation time, lesion size, and operation location were risk factors for post-ESD fever. Multivariate logistic stepwise regression was performed for the above statistically significant factors to control for confounding factors. The results showed that age above 60 (OR=1.045, 95% CI: 0.945-2.145, P=0.002), esophageal mucosal defect of more than 3/4 (OR=8.231, 95% CI: 6,745-11.342, P=0.033), and diabetes (OR=2.143, 95% CI: 1.345-4.236, P=0.034) were independent risk factors for esophageal stenosis after ESD. Conclusion: This study indicated that patients who are older, whose operation site is in the esophagus, who have diabetes or large tumors, and long operation time were more likely to develop post-ESD fever, but there was a low probability that bacteremia was the cause of fever. Patients after ESD may show some manifestations of inflammatory reactions, but the possibility of bacteremia is small.