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Predictive factors for difficult endoscopic submucosal dissection for esophageal neoplasia including failure of en bloc resection or perforation

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Abstract

Background

Endoscopic submucosal dissection (ESD) is accepted as the standard treatment for early-stage esophageal neoplasia. However, esophageal perforation may occur, leading to mediastinitis and pneumothorax, which occasionally require emergency surgery. Moreover, failure of en bloc resection causes local recurrence. However, studies on the predictors of such difficulties during ESD are limited. Hence, we evaluated the predictors associated with the difficulty of ESD for esophageal neoplasia including failure of en bloc resection or perforation.

Methods

Data of 549 consecutive patients who were treated with ESD between May 2004 and March 2016 at a single institution were retrospectively studied. Exclusion criteria were the presence of metachronous esophageal neoplasia or missing data. The primary outcome was determining the predictors associated with the difficulty of ESD for esophageal neoplasia including failure of en bloc resection or perforation.

Results

Altogether, 543 patients with 736 lesions were evaluated. Failure of en bloc resection occurred in 6 patients (1.1%) with 6 lesions, and perforation occurred in 11 patients (2.0%) with 11 lesions (1.5%). Multivariate logistic regression analysis showed that large lesion diameter (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.21–1.84; p < 0.001) and previous chemoradiotherapy (OR 5.24; 95% CI 1.52–18.06; p = 0.009) were independent predictive factors.

Conclusions

Larger lesions and previous chemoradiotherapy for esophageal cancer increased the risk for failure of en bloc resection or perforation in patients who underwent esophageal ESD.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Yasuaki Nagami, Masaki Ominami, Taishi Sakai, Hirotsugu Maruyama, Shusei Fukunaga, Koji Otani, Shuhei Hosomi, Fumio Tanaka, Noriko Kamata, Koichi Taira, Tetsuya Tanigawa, Masatsugu Shiba, Toshio Watanabe & Yasuhiro Fujiwara

  2. Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan

    Masatsugu Shiba

Authors
  1. Yasuaki Nagami
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  2. Masaki Ominami
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  3. Taishi Sakai
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  4. Hirotsugu Maruyama
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  5. Shusei Fukunaga
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  7. Shuhei Hosomi
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  11. Tetsuya Tanigawa
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  12. Masatsugu Shiba
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  14. Yasuhiro Fujiwara
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Correspondence to Yasuaki Nagami.

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Disclosures

Drs. Nagami, Ominami, Sakai, Maruyama, Fukunaga, Otani, Hosomi, Tanaka, Taira, Kamata, Tanigawa, Shiba, Watanabe, Fujiwara have no conflicts of interest or financial ties to disclose.

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Nagami, Y., Ominami, M., Sakai, T. et al. Predictive factors for difficult endoscopic submucosal dissection for esophageal neoplasia including failure of en bloc resection or perforation. Surg Endosc 35, 3361–3369 (2021). https://doi.org/10.1007/s00464-020-07777-0

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  • DOI: https://doi.org/10.1007/s00464-020-07777-0

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