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

Authors

Zhenkai Luo, Yuanshun Liu, Rongwei Ruan, Yujia Zhai, Yifan Jia, Ningxia Zhang, Yuanhan Zhao, Shi Wang

Published in

Surgical endoscopy. Aug 10, 2026. Epub Aug 10, 2026.

Abstract

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.

PMID:
42576084
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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