Skip to main content
Log in

Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic dilation (ED) is used for the treatment of benign strictures caused by reflux esophagitis or anastomotic stenosis after esophagectomy. Esophageal stenosis is a major complication after endoscopic submucosal dissection (ESD) of large superficial esophageal cancer, but little is known regarding the incidence of complications of ED for stenosis caused by esophageal ESD.

Methods

This was a retrospective study conducted at a single institution. From September 2002 to December 2012, a total of 1,337 ED procedures were performed for stenosis after esophageal ESD in 121 patients. The incidence of complications of ED and related clinical characteristics were analyzed.

Results

The incidence of bleeding was 0.8 % (1/121) per patient and 0.07 % (1/1,337) per procedure. The incidence of perforation was 4.1 % (5/121) per patient and 0.37 % (5/1,337) per procedure. Perforation occurred at a median of third time of ED procedures (range 2–9 procedures) and at a median of 18 days (range 8–29 days) after ESD. There were no significant characteristics correlated to perforation, such as location, circumferential extent, or diameter of mucosal defect after ESD. The total number of ED procedures was significantly larger among perforation cases (37, range 6–57) compared with those without perforation (7, range 1–70) (p = 0.01), and the treatment duration tended to be longer (190 vs. 69 days, respectively).

Conclusions

The incidence of bleeding caused by ED for esophageal stenosis after ESD was very low. Relevant risk of perforation should be considered for patients requiring multiple ED procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Takahashi H, Arimura Y, Masao H, Okahara S, Tanuma T, Kodaira J, Kagaya H, Shimizu Y, Hokari K, Tsukagoshi H, Shinomura Y, Fujita M (2010) Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 72:255–264; 264.e1–264.e2

  2. Kakushima N, Fujishiro M (2008) Endoscopic submucosal dissection for gastrointestinal neoplasms. World J Gastroenterol 14:2962–2967

    Article  PubMed Central  PubMed  Google Scholar 

  3. Mizuta H, Nishimori I, Kuratani Y, Higashidani Y, Kohsaki T, Onishi S (2009) Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus 22:626–631

    Article  CAS  PubMed  Google Scholar 

  4. Katada C, Muto M, Manabe T, Boku N, Ohtsu A, Yoshida S (2003) Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc 57:165–169

    Article  PubMed  Google Scholar 

  5. Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, Omata M (2009) Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy 41:661–665

    Article  CAS  PubMed  Google Scholar 

  6. Hanaoka N, Ishihara R, Takeuchi Y, Uedo N, Higashino K, Ohta T, Kanzaki H, Hanafusa M, Nagai K, Matsui F, Iishi H, Tatsuta M, Ito Y (2012) Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy 44:1007–1011

    Article  CAS  PubMed  Google Scholar 

  7. Wong VW, Teoh AY, Fujishiro M, Chiu PW, Ng EK (2010) Preemptive dilatation gives good outcome to early esophageal stricture after circumferential endoscopic submucosal dissection. Surg Laparosc Endosc Percutan Tech 20:e25–e27

    Article  PubMed  Google Scholar 

  8. Ezoe Y, Muto M, Horimatsu T, Morita S, Miyamoto S, Mochizuki S, Minashi K, Yano T, Ohtsu A, Chiba T (2011) Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol 45:222–227

    Article  PubMed  Google Scholar 

  9. Yoda Y, Yano T, Kaneko K, Tsuruta S, Oono Y, Kojima T, Minashi K, Ikematsu H, Ohtsu A (2012) Endoscopic balloon dilatation for benign fibrotic strictures after curative nonsurgical treatment for esophageal cancer. Surg Endosc 26:2877–2883

    Article  PubMed  Google Scholar 

  10. Coda S, Oda I, Gotoda T, Yokoi C, Kikuchi T, Ono H (2009) Risk factors for cardiac and pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment. Endoscopy 41:421–426

    Article  CAS  PubMed  Google Scholar 

  11. Kakushima N, Tanaka M, Sawai H, Imai K, Kawata N, Hagiwara T, Takao T, Hotta K, Yamaguchi Y, Takizawa K, Matsubayashi H, Ono H (2013) Gastric obstruction after endoscopic submucosal dissection. United Eur Gastroenterol J 1:184–190

    Article  Google Scholar 

  12. Tsunada S, Ogata S, Mannen K, Arima S, Sakata Y, Shiraishi R, Shimoda R, Ootani H, Yamaguchi K, Fujise T, Sakata H, Iwakiri R, Fujimoto K (2008) Case series of endoscopic balloon dilation to treat a stricture caused by circumferential resection of the gastric antrum by endoscopic submucosal dissection. Gastrointest Endosc 67:979–983

    Article  PubMed  Google Scholar 

  13. Pereira-Lima JC, Ramires RP, Zamin I Jr, Cassal AP, Marroni CA, Mattos AA (1999) Endoscopic dilation of benign esophageal strictures: report on 1043 procedures. Am J Gastroenterol 94:1497–1501

    Article  CAS  PubMed  Google Scholar 

  14. Piotet E, Escher A, Monnier P (2008) Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique. Eur Arch Otorhinolaryngol 265:357–364

    Article  PubMed  Google Scholar 

  15. Jacobs JW Jr, Spechler SJ (2010) A systematic review of the risk of perforation during esophageal dilation for patients with eosinophilic esophagitis. Dig Dis Sci 55:1512–1515

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Fujimoto K, Fujishiro M, Kato M, Higuchi K, Iwakiri R, Sakamoto C, Uchiyama S, Kashiwagi A, Ogawa H, Murakami K, Mine T, Yoshino J, Kinoshita Y, Ichinose M, Matsui T (2014) Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 26:1–14

    Article  PubMed  Google Scholar 

  17. Kakushima N, Fujishiro M, Kodashima S, Kobayashi K, Tateishi A, Iguchi M, Imagawa A, Motoi T, Yahagi N, Omata M (2006) Histopathologic characteristics of gastric ulcers created by endoscopic submucosal dissection. Endoscopy 38:412–415

    Article  CAS  PubMed  Google Scholar 

  18. Honda M, Nakamura T, Hori Y, Shionoya 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 42:1092–1095

    Article  CAS  PubMed  Google Scholar 

  19. Ota M, Ohki T, Nakamura T, Hayashi K, Yamamoto M (2010) Investigation of ulcer healing after esophageal EMR/ESD. Esophagus 7:101–104

    Article  Google Scholar 

  20. Takahashi H, Arimura Y, Okahara S, Uchida S, Ishigaki S, Tsukagoshi H, Shinomura Y, Hosokawa M (2011) Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma. Endoscopy 43:184–189

    Article  CAS  PubMed  Google Scholar 

  21. ASGE Standards of Practice Committee, Anderson MA, Ben-Menachem T, Gan SI, Appalaneni V, Banerjee S, Cash BD, Fisher L, Harrison ME, Fanelli RD, Fukami N, Ikenberry SO, Jain R, Khan K, Krinsky ML, Lichtenstein DR, Maple JT, Shen B, Strohmeyer L, Baron T, Dominitz JA (2009) Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 70:1060–1070

    Article  Google Scholar 

  22. Veitch AM, Baglin TP, Gershlick AH, Harnden SM, Tighe R, Cairns S, British Society of G, British Committee for Standards in H, British Cardiovascular Intervention S (2008) Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut 57:1322–1329

    Article  CAS  PubMed  Google Scholar 

  23. Boustiere C, Veitch A, Vanbiervliet G, Bulois P, Deprez P, Laquiere A, Laugier R, Lesur G, Mosler P, Nalet B, Napoleon B, Rembacken B, Ajzenberg N, Collet JP, Baron T, Dumonceau JM, European Society of Gastrointestinal E (2011) Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 43:445–461

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

Y Kishida, N Kakushima, N Kawata, M Tanaka, K Takizawa, K Imai, K Hotta, H Matsubayashi, and H Ono have no conflict of interest or financial interests to declare in association with this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yoshihiro Kishida.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kishida, Y., Kakushima, N., Kawata, N. et al. Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer. Surg Endosc 29, 2953–2959 (2015). https://doi.org/10.1007/s00464-014-4028-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-4028-2

Keywords

Navigation