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Background Fever is a noted complication after anesthetized GI endoscopy, with intraoperative hypothermia as a key factor. Routine postoperative warming may be insufficient if intraoperative heat loss is pivotal. This trial compared the strategies of ‘intra- and post-procedural continuous warming’ versus ‘post-procedural warming only’ to reduce fever incidence in patients undergoing combined anesthetized gastroscopy and colonoscopy.Methods A randomized controlled trial was conducted from Dec 1-31, 2025. Patients were randomized to: a control group receiving a warming blanket only in recovery, or a study group receiving continuous warming from procedure start through recovery. Core temperature was monitored every 3 minutes via tympanic thermometer. The primary outcome was the incidence of fever (≥37.5°C) within 2 hours post-procedure. Secondary outcomes included intraoperative core temperature change measured using a tympanic thermometer, shivering, and 48-hour cumulative fever/discomfort via follow-up.Results 1204 patients were enrolled. The immediate fever rate (within 2h) was slightly lower in the study group (0% vs. 0.1%, P>0.05). The study group showed a smaller decrease in intraoperative core temperature and lower shivering incidence. The 48-hour cumulative fever incidence was marginally lower in the study group (0.1% vs. 1.5%, P>0.05).Conclusions For combined anesthetized gastroscopy/colonoscopy, continuous intra- and post-procedural warming better maintained core temperature and showed a trend toward reducing fever within 48 hours compared to postoperative warming only. Preventing intraoperative hypothermia may help lower post-procedural fever. Initiating active warming at procedure start is a potentially effective strategy.