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Frequent occurrence of fever in patients who have undergone endoscopic submucosal dissection for colorectal tumor, but bacteremia is not a significant cause

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Abstract

Background

We examined the incidence of and factors associated with fever, as well as the frequency of bacteremia, in patients who had undergone endoscopic submucosal dissection (ESD) for colorectal tumor.

Method

A total of 199 patients (120 male and 79 female) were included. The patients were classified into two groups based on the body temperature on the day after ESD treatment: group A, body temperature <37 °C; and group B, body temperature ≥37 °C. The following factors were analyzed to determine their potential association with post-ESD fever: gender, age, tumor size, form, location, and presence or absence of intraoperative perforation. In addition, blood samples from 50 patients were obtained for blood culture and 16S rRNA gene analysis by polymerase chain reaction.

Results

Group A included 106 patients (70 male and 36 female), with a median age of 63 years. Group B included 93 patients (50 male and 43 female), with a median age of 70 years. The incidence of post-ESD fever in the entire cohort was 46.7 %. Univariate analysis based on comparison between groups A and B showed that the following factors were significantly associated with post-ESD fever: age [mean ± standard deviation (SD)], 64.5 ± 9.2 versus 68.5 ± 10.8 years, P = 0.006; and tumor size (mean ± SD) 30.6 ± 10.8 versus 39.1 ± 16.6 mm, P < 0.001. Logistic regression analysis for post-ESD fever also found that age {odds ratio 1.04 (95 % CI [1.01–1.07], P = 0.009)} and lesion size {odds ratio 1.05 (95 % CI [1.03–1.08], P = 0.0002)} were closely associated with post-ESD fever. Of the 50 patients who had blood samples cultured and 16S rRNA gene analyzed, bacteria in blood culture and the 16S rRNA gene were not detectable in any of the samples from the 50 patients.

Conclusions

This study indicated that older patients and patients with large tumors were more likely to develop post-ESD fever, but there was a low probability that bacteremia was the cause of fever.

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Acknowledgments

This work was supported in part by Grant-in-Aid for Scientific Research (C) (No. 23591023 to TO and NS) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Disclosures

Kentaro Izumi, Taro Osada, Naoto Sakamoto, Tomohiro Kodani, Yoshie Higashihara, Hideaki Ritsuno, Tomoyoshi Shibuya, Akihito Nagahara, Tatsuo Ogihara, Ken Kikuchi and Sumio Watanabe have no conflict of interest or financial ties to disclose.

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Correspondence to Taro Osada.

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Trial registration UMIN-CTR UMIN000008245.

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Izumi, K., Osada, T., Sakamoto, N. et al. Frequent occurrence of fever in patients who have undergone endoscopic submucosal dissection for colorectal tumor, but bacteremia is not a significant cause. Surg Endosc 28, 2899–2904 (2014). https://doi.org/10.1007/s00464-014-3551-5

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  • DOI: https://doi.org/10.1007/s00464-014-3551-5

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