Tomohiro Miwata1, Shiro Oka2,3, Shinji Tanaka4, Kenichi Kagemoto1, Yoji Sanomura4, Yuji Urabe1, Toru Hiyama5, Kazuaki Chayama1. 1. Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. 2. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. oka4683@hiroshima-u.ac.jp. 3. Department of Gastroenterology and Metabolism, Graduate Departments of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. oka4683@hiroshima-u.ac.jp. 4. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. 5. Health Service Center, Hiroshima University, Higashihiroshima, Japan.
Abstract
BACKGROUND: Endoscopic submucosal dissection (ESD) is used to perform en block resection for esophageal squamous cell carcinoma, but it is strongly associated with postoperative stenosis, especially during entire circumferential resection. This study aimed to clarify the risk factors for refractory postoperative stenosis after entire circumferential esophageal ESD. METHODS: Nineteen patients who underwent entire circumferential esophageal ESD from February 2006 to December 2013 at Hiroshima University Hospital were divided into two groups: refractory postoperative stenosis [≥6 endoscopic balloon dilation (EBD) procedures, 12 lesions in 12 patients] and non-refractory postoperative stenosis (≤5 EBD procedures, 7 lesions in 7 patients). We retrospectively examined the patient factors (age, sex, alcohol consumption, smoking index, and chemoradiation therapy history), tumor factors (location, macroscopic type, fibrosis, and depth), and treatment factors (mean procedure time, entire circumferential resection diameter, muscle layer damage, and steroid administration method) between the two groups. RESULTS: Muscle layer damage (p = 0.019) and ≥5 cm of longitudinal mucosal defect length after entire circumferential esophageal ESD (p = 0.010) were significant factors associated with the refractory group. Regarding the patient and tumor factors, there were no significant differences between the two groups. CONCLUSION: Our data suggest that refractory post-ESD stenosis occurs after entire circumferential esophageal ESD with muscle layer damage and ≥5 cm of longitudinal mucosal defect length.
BACKGROUND: Endoscopic submucosal dissection (ESD) is used to perform en block resection for esophageal squamous cell carcinoma, but it is strongly associated with postoperative stenosis, especially during entire circumferential resection. This study aimed to clarify the risk factors for refractory postoperative stenosis after entire circumferential esophageal ESD. METHODS: Nineteen patients who underwent entire circumferential esophageal ESD from February 2006 to December 2013 at Hiroshima University Hospital were divided into two groups: refractory postoperative stenosis [≥6 endoscopic balloon dilation (EBD) procedures, 12 lesions in 12 patients] and non-refractory postoperative stenosis (≤5 EBD procedures, 7 lesions in 7 patients). We retrospectively examined the patient factors (age, sex, alcohol consumption, smoking index, and chemoradiation therapy history), tumor factors (location, macroscopic type, fibrosis, and depth), and treatment factors (mean procedure time, entire circumferential resection diameter, muscle layer damage, and steroid administration method) between the two groups. RESULTS:Muscle layer damage (p = 0.019) and ≥5 cm of longitudinal mucosal defect length after entire circumferential esophageal ESD (p = 0.010) were significant factors associated with the refractory group. Regarding the patient and tumor factors, there were no significant differences between the two groups. CONCLUSION: Our data suggest that refractory post-ESD stenosis occurs after entire circumferential esophageal ESD with muscle layer damage and ≥5 cm of longitudinal mucosal defect length.
Authors: M Giovannini; E Bories; C Pesenti; V Moutardier; G Monges; C Danisi; B Lelong; J R Delpero Journal: Endoscopy Date: 2004-09 Impact factor: 10.093
Authors: T Mizumoto; T Hiyama; S Oka; N Yorita; K Kuroki; M Kurihara; Y Yoshifuku; Y Sanomura; Y Urabe; Y Murakami; K Arihiro; S Tanaka; K Chayama Journal: Dig Dis Sci Date: 2018-03-21 Impact factor: 3.199