Endoscopy 2016; 48(01): 62-70
DOI: 10.1055/s-0034-1392514
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Risk of stricture after endoscopic submucosal dissection for large rectal neoplasms

Yoshiko Ohara
1   Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Takashi Toyonaga
2   Department of Endoscopy, Kobe University Hospital, Kobe, Japan
3   Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Shinwa Tanaka
2   Department of Endoscopy, Kobe University Hospital, Kobe, Japan
,
Tsukasa Ishida
1   Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Namiko Hoshi
1   Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Tetsuya Yoshizaki
2   Department of Endoscopy, Kobe University Hospital, Kobe, Japan
,
Fumiaki Kawara
2   Department of Endoscopy, Kobe University Hospital, Kobe, Japan
,
Ka Luen Lui
4   Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China
,
Kanokkan Tepmalai
5   Unit of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
,
Alisara Damrongmanee
6   Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
,
Mitsuru Nagata
7   Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Yoshinori Morita
1   Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Eiji Umegaki
1   Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Takeshi Azuma
1   Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
› Author Affiliations
Further Information

Publication History

submitted 10 December 2014

accepted after revision 14 May 2015

Publication Date:
28 July 2015 (online)

Background and study aims: Improvements in the endoscopic submucosal dissection (ESD) technique have made circumferential ESD in the rectum possible. However, little is known about the clinical course after extensive ESD in the rectum. The aim of this study was to determine the stricture risk in the rectum after total or subtotal circumferential ESD.

Patients and methods: A total of 69 patients with 69 rectal tumors that required ≥ 75 % circumferential resection were identified at Kobe University Hospital and an affiliated hospital between April 2005 and May 2014. Among the patients, 61 were available for evaluation of stricture development, either by follow-up colonoscopy or by surgical specimens. The rate and possible risk factors of post-ESD strictures were investigated.

Results: Post-ESD rectal strictures developed in 12 patients (19.7 %). Patients who underwent total circumferential ESD developed a stricture (5/7, 71.4 %) more frequently than those with subtotal (≥ 90 %) ESD (7/16, 43.8 %). Patients undergoing an ESD procedure that involved < 90 % of the circumference did not develop strictures. The strictures were membranous or < 10 mm long in all cases. Of the patients with stricture, 11 received endoscopic balloon dilation and one received bougie with short-caliber-tip transparent hood; all strictures improved following dilation therapy. Statistical analysis revealed that ≥ 90 % circumferential resection was an independent risk factor for stricture, whereas morphology and size were not.

Conclusions: Patients who underwent total or subtotal circumferential ESD of a rectal tumor had a high risk of stricture formation. Dilation helped to alleviate the stenosis.

Study registered at University Hospital Medical Information Network (UMIN 000016559).

 
  • References

  • 1 Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer 2007; 10: 1-11
  • 2 Oka S, Tanaka S, Kaneko I et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006; 64: 877-883
  • 3 Yokoi C, Gotoda T, Hamanaka H et al. Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc 2006; 64: 212-218
  • 4 Kiriyama S, Saito Y, Matsuda T et al. Comparing endoscopic submucosal dissection with transanal resection for non-invasive rectal tumor: a retrospective study. J Gastroenterol Hepatol 2011; 26: 1028-1033
  • 5 Nakajima T, Saito Y, Tanaka S et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 2013; 27: 3262-3270
  • 6 Terasaki M, Tanaka S, Oka S et al. Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 2012; 27: 734-740
  • 7 Toyonaga T, Man-i M, East JE et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
  • 8 Ohata K, Nonaka K, Minato Y et al. Endoscopic submucosal dissection for large colorectal tumor in a Japanese general hospital. J Oncol 2013; 2013: 218670
  • 9 Lee EJ, Lee JB, Lee SH et al. Endoscopic submucosal dissection for colorectal tumors – 1,000 colorectal ESD cases: one specialized institute’s experiences. Surg Endosc 2013; 27: 31-39
  • 10 Toyonaga T, Man-i M, Fujita T et al. Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy 2010; 42: 714-722
  • 11 Nawata Y, Homma K, Suzuki Y. Retrospective study of technical aspects and complications of endoscopic submucosal dissection for large superficial colorectal tumors. Dig Endosc 2014; 26: 552-555
  • 12 Katada C, Muto M, Manabe T et al. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc 2003; 57: 165-169
  • 13 Mizuta H, Nishimori I, Kuratani Y et al. Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus 2009; 22: 626-631
  • 14 Ono S, Fujishiro M, Niimi K et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy 2009; 41: 661-665
  • 15 Shi Q, Ju H, Yao LQ et al. Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma. Endoscopy 2014; 46: 640-644
  • 16 Coda S, Oda I, Gotoda T et al. Risk factors for cardiac and pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment. Endoscopy 2009; 41: 421-426
  • 17 Iizuka H, Kakizaki S, Sohara N et al. Stricture after endoscopic submucosal dissection for early gastric cancers and adenomas. Dig Endosc 2010; 22: 282-288
  • 18 Kakushima N, Tanaka M, Sawai H et al. Gastric obstruction after endoscopic submucosal dissection. United European Gastroenterol J 2013; 1: 184-190
  • 19 Yamaguchi N, Isomoto H, Nakayama T et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 2011; 73: 1115-1121
  • 20 Ezoe Y, Muto M, Horimatsu T et al. Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol 2011; 45: 222-227
  • 21 Isomoto H, Yamaguchi N, Minami H et al. Management of complications associated with endoscopic submucosal dissection/endoscopic mucosal resection for esophageal cancer. Dig Endosc 2013; 25: 29-38
  • 22 Isomoto H, Yamaguchi N, Nakayama T et al. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. BMC Gastroenterol 2011; 11: 46
  • 23 Hashimoto S, Kobayashi M, Takeuchi M et al. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 2011; 74: 1389-1393
  • 24 Sato H, Inoue H, Kobayashi Y et al. Control of severe strictures after circumferential endoscopic submucosal dissection for esophageal carcinoma: oral steroid therapy with balloon dilation or balloon dilation alone. Gastrointest Endosc 2013; 78: 250-257
  • 25 Tanaka S, Kashida H, Saito Y et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
  • 26 Toyonaga T, Man-I M, Fujita T et al. The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case-control study. Aliment Pharmacol Ther 2010; 32: 908-915
  • 27 Seno H, Miyoshi H, Brown SL et al. Efficient colonic mucosal wound repair requires Trem2 signaling. Proc Natl Acad Sci U S A 2009; 106: 256-261