Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma
- 558 Downloads
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.
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.
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.
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.
KeywordsEsophageal squamous cell carcinoma Surgical procedure Endoscopic Stenosis Steroids Risk factors
Compliance with ethical standards
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.
- 5.Hanaoka N, Ishihara R, Takeuchi Y, Uedo N, Higashino K, Ohta T, Kanzaki H, Hanafusa M, Nagai K, Matsui F, Lishi H, Tatsuya M, Ito Y (2012) Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy 44:1007–1011CrossRefPubMedGoogle Scholar
- 6.Yamaguchi N, Isomoto H, Nakayama T, Hayashi T, Nishiyama H, Ohnita K, Takeshima F, Shikuwa S, Kohno S, Nakao K (2011) Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 73:1115–1121CrossRefPubMedGoogle Scholar
- 9.The International Agency for Research on Cancer (2010) WHO classification of tumours of the digestive system. IARC Press, LyonGoogle Scholar
- 12.Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2009) Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Dig Endosc 4:688–694Google Scholar
- 13.Isomoto H, Yamaguchi N, Nakayama T, Hayashi T, Nishiyama H, Ohnita K, Takeshima F, Shikuwa S, Kohno S, Nakao K (2011) Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. BMC Gastroenterol 11:46CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Cheng AL, Hsiung CA, Su IJ, Chen PJ, Chang MC, Tsao CJ, Kao WY, Uen WC, Hsu CH, Tien HF, Chao TY, Chen LT, Whang-Peng J, Lymphoma Committee of Taiwan Cooperative Oncology Group (2003) Steroid-free chemotherapy decreases risk of hepatitis B virus (HBV) reactivation in HBV-carriers with lymphoma. Hepatology 37:1320–1328CrossRefPubMedGoogle Scholar
- 16.Honda M, Nakamura T, Hori Y, Shinoya Y, Nakada A, Sato T, Yamamoto K, Kobayashi T, Shimada H, Kida N, Hashimoto A, Hashimoto Y (2010) Process of healing of mucosal defects in the esophagus after endoscopic mucosal resection: histological evaluation in a dog model. Endoscopy 42:1092–1095CrossRefPubMedGoogle Scholar
- 19.Sato H, Inoue H, Kobayashi Y, Maselli R, Santi EG, Hayee B, Igarashi K, Yoshida A, Ikeda H, Onimaru M, Aoyagi Y, Kudo SE (2013) Control of severe strictures after circumferential endoscopic submucosal dissection for esophageal carcinoma: oral steroid therapy with balloon dilation or balloon dilation alone. Gastrointest Endosc 78:250–257CrossRefPubMedGoogle Scholar
- 20.Takahashi H, Arimura Y, Okahara S, Kodaira J, Hokari K, Tsukagoshi H, Shinomura Y, Hosokawa M (2015) A randomized controlled trial of endoscopic steroid injection for prophylaxis of esophageal stenoses after extensive endoscopic submucosal dissection. BMC Gastroenterol 22(15):1CrossRefGoogle Scholar
- 21.Yamaguchi N, Isomoto H, Shikuwa S, Nakayama T, Hayashi T, Onita K, Takeshima F, Kohno S, Nakao K (2011) Effect of oral prednisolone on esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: a case report. Digestion 83:291–295CrossRefPubMedGoogle Scholar
- 24.Kataoka K, Aoyama I, Mizusawa J, Eba J, Minashi K, Yano T, Tanaka M, Hanaoka N, Katayama H, Takizawa K, Fukuda H, Muto M, Gastrointestinal Endoscopy Study Group (GIESG) of the Japan Clinical Oncology Group (2015) A randomized controlled Phase II/III study comparing endoscopic balloon dilation combined with steroid injection versus radial incision and cutting combined with steroid injection for refractory anastomotic stricture after esophagectomy: Japan Clinical Oncology Group Study JCOG1207. Jpn J Clin Oncol 45:385–389CrossRefPubMedGoogle Scholar
- 25.Giovannini M, Bories E, Pesenti C, Moutardier V, Monges G, Danisi C, Lelong B, Delpero JR (2004) Circumferential endoscopic mucosal resection in Barrett”s esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients. Endoscopy 36:782–787CrossRefPubMedGoogle Scholar