Yoshihiro Kishida1, Naomi Kakushima2, Noboru Kawata3, Masaki Tanaka3, Kohei Takizawa3, Kenichiro Imai3, Kinichi Hotta3, Hiroyuki Matsubayashi3, Hiroyuki Ono3. 1. Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan. y.kishida@scchr.jp. 2. Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan. kakushin-tky@umin.ac.jp. 3. Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan.
Abstract
BACKGROUND: Endoscopic dilation (ED) is used for the treatment of benign strictures caused by reflux esophagitis or anastomotic stenosis after esophagectomy. Esophageal stenosis is a major complication after endoscopic submucosal dissection (ESD) of large superficial esophageal cancer, but little is known regarding the incidence of complications of ED for stenosis caused by esophageal ESD. METHODS: This was a retrospective study conducted at a single institution. From September 2002 to December 2012, a total of 1,337 ED procedures were performed for stenosis after esophageal ESD in 121 patients. The incidence of complications of ED and related clinical characteristics were analyzed. RESULTS: The incidence of bleeding was 0.8 % (1/121) per patient and 0.07 % (1/1,337) per procedure. The incidence of perforation was 4.1 % (5/121) per patient and 0.37 % (5/1,337) per procedure. Perforation occurred at a median of third time of ED procedures (range 2-9 procedures) and at a median of 18 days (range 8-29 days) after ESD. There were no significant characteristics correlated to perforation, such as location, circumferential extent, or diameter of mucosal defect after ESD. The total number of ED procedures was significantly larger among perforation cases (37, range 6-57) compared with those without perforation (7, range 1-70) (p = 0.01), and the treatment duration tended to be longer (190 vs. 69 days, respectively). CONCLUSIONS: The incidence of bleeding caused by ED for esophageal stenosis after ESD was very low. Relevant risk of perforation should be considered for patients requiring multiple ED procedures.
BACKGROUND: Endoscopic dilation (ED) is used for the treatment of benign strictures caused by reflux esophagitis or anastomotic stenosis after esophagectomy. Esophageal stenosis is a major complication after endoscopic submucosal dissection (ESD) of large superficial esophageal cancer, but little is known regarding the incidence of complications of ED for stenosis caused by esophageal ESD. METHODS: This was a retrospective study conducted at a single institution. From September 2002 to December 2012, a total of 1,337 ED procedures were performed for stenosis after esophageal ESD in 121 patients. The incidence of complications of ED and related clinical characteristics were analyzed. RESULTS: The incidence of bleeding was 0.8 % (1/121) per patient and 0.07 % (1/1,337) per procedure. The incidence of perforation was 4.1 % (5/121) per patient and 0.37 % (5/1,337) per procedure. Perforation occurred at a median of third time of ED procedures (range 2-9 procedures) and at a median of 18 days (range 8-29 days) after ESD. There were no significant characteristics correlated to perforation, such as location, circumferential extent, or diameter of mucosal defect after ESD. The total number of ED procedures was significantly larger among perforation cases (37, range 6-57) compared with those without perforation (7, range 1-70) (p = 0.01), and the treatment duration tended to be longer (190 vs. 69 days, respectively). CONCLUSIONS: The incidence of bleeding caused by ED for esophageal stenosis after ESD was very low. Relevant risk of perforation should be considered for patients requiring multiple ED procedures.
Authors: Michelle A Anderson; Tamir Ben-Menachem; S Ian Gan; Vasundhara Appalaneni; Subhas Banerjee; Brooks D Cash; Laurel Fisher; M Edwyn Harrison; Robert D Fanelli; Norio Fukami; Steven O Ikenberry; Rajeev Jain; Khalid Khan; Mary Lee Krinsky; David R Lichtenstein; John T Maple; Bo Shen; Laura Strohmeyer; Todd Baron; Jason A Dominitz Journal: Gastrointest Endosc Date: 2009-11-03 Impact factor: 9.427
Authors: H Takahashi; Y Arimura; S Okahara; S Uchida; S Ishigaki; H Tsukagoshi; Y Shinomura; M Hosokawa Journal: Endoscopy Date: 2011-01-13 Impact factor: 10.093