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Surgical Endoscopy
Erschienen in:

03.08.2020

Independent risk factors for esophageal refractory stricture after extensive endoscopic submucosal dissection

verfasst von: Jian Tang, Fanyang Kong, Jun Li, Feng Liu, Xiangyu Kong, Zhaoshen Li

Erschienen in: Surgical Endoscopy | Ausgabe 7/2021

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Abstract

Background

Endoscopic submucosal dissection (ESD) is accepted as a standard therapeutic technique for superficial esophageal neoplasms (SENs). However, esophageal refractory stricture is a serious adverse event secondary to extensive ESD (≥ 3/4 of the luminal circumference). This retrospective study aimed to investigate the risk factors for refractory postoperative stricture after extensive ESD.

Methods

The data of patients who underwent esophageal ESD at the Endoscopy Center of Changhai Hospital were reviewed between January 2011 and September 2019. Risk factors for postoperative refractory stricture [≥ 6 sessions of endoscopic balloon dilation (EBD)] after extensive ESD were then identified using univariate analysis and multivariate logistic regression analysis.

Results

A total of 69 SENs in 67 patients treated by extensive ESD were enrolled in this study. The refractory stricture incidence was 62% (43/69). Significant differences between non-refractory stricture group and refractory stricture group were observed in depth of infiltration (m1or m2/m3 or sm1:20/6 vs. 17/26, P = 0.003), longitudinal resection length (< 50 mm/ ≥ 50 mm:19/7 vs. 10/33, P < 0.001), circumferential range (3/4~ < 1/1:20/6 vs. 19/24, P = 0.008), muscular injury (NO/YES:18/8 vs. 19/24, P = 0.043), and clip number (≤ 5/ > 5:15/11 vs. 12/31, P = 0.014). Multivariate analysis revealed that longitudinal resection length ≥ 50 mm (odds ratio [OR] 11.099, 95% confidence interval [CI] 2.620–47.019), depth of infiltration above m2 (OR 5.716, 95%CI 1.324–24.672) and muscular injury happened (OR 4.431, 95%CI 1.052–18.659) were independent risk factors for refractory stricture. In addition, the EBD sessions for treatment of refractory stricture was related to longitudinal resection length (relation coefficient γ = 0.528; P  <0.05).

Conclusions

The longitudinal resection length, depth of tumor infiltration and muscular injury are the reliable risk factors for esophageal refractory stricture after extensive ESD.
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Metadaten
Titel
Independent risk factors for esophageal refractory stricture after extensive endoscopic submucosal dissection
verfasst von
Jian Tang
Fanyang Kong
Jun Li
Feng Liu
Xiangyu Kong
Zhaoshen Li
Publikationsdatum
03.08.2020
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 7/2021
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07840-w

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