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Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma

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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.

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Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

    Tomohiro Miwata, Kenichi Kagemoto, Yuji Urabe & Kazuaki Chayama

  2. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan

    Shiro Oka, Shinji Tanaka & Yoji Sanomura

  3. Health Service Center, Hiroshima University, Higashihiroshima, Japan

    Toru Hiyama

  4. Department of Gastroenterology and Metabolism, Graduate Departments of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Shiro Oka

Authors
  1. Tomohiro Miwata
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  2. Shiro Oka
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Correspondence to Shiro Oka.

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Disclosures

Tomohiro Miwata, Shiro Oka, Shinji Tanaka, Kenichi Kagemoto, Yoji Sanomura, Yuji Urabe, Toru Hiyama, and Kazuaki Cyayama have no conflicts of interest or financial ties to disclose.

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Miwata, T., Oka, S., Tanaka, S. et al. Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Surg Endosc 30, 4049–4056 (2016). https://doi.org/10.1007/s00464-015-4719-3

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  • DOI: https://doi.org/10.1007/s00464-015-4719-3

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