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Self-help inflatable balloon versus autologous skin-grafting surgery for preventing esophageal stricture after complete circular endoscopic submucosal dissection: a propensity score matching analysis

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Abstract

Background

The self-help inflatable balloon (SHIB) and autologous skin-grafting surgery (ASGS) were used to prevent stricture after esophageal complete circular endoscopic submucosal dissection (cESD) with promising clinical results. We aim to evaluate which method is more suitable for patients who underwent esophageal cESD.

Methods

From October 2017 to July 2021, patients whose mucosal defect length were between 30 and 100 mm after esophageal cESD were retrospectively reviewed from two prospective studies. They were enrolled once SHIB or ASGS was used as preventive methods to prevent stricture. Propensity score matching (PSM) was used to balance the baseline characteristics between the two groups. Comparisons were made between the two groups, including operation time, the longitudinal length of ulceration, fasting time, hospitalization days, and the incidence of stricture.

Results

A total of 41 patients who met the inclusion criteria were enrolled in the study. The numbers of patients in SHIB group and ASGS group were 25 and 16, respectively. Fifteen patients in each group were selected after performing PSM. The basic baseline characteristics were comparable between the two groups. The stricture rates were 20% (3/15) in SHIB group and 40% (6/15) in ASGS group, while the difference was not statistically significant (p = 0.427). The SHIB group showed significantly shorter operation time, shorter hospitalization days, lower cost, and longer removing balloon/stent time compared with ASGS group (p < 0.001). Comparison of relevant stricture factors between the stricture group and non-stricture group revealed that longer longitudinal length of ulceration (> 60 mm) accounted for a higher proportion in stricture groups (p = 0.035).

Conclusion

Both the SHIB and ASGS had high efficacy and safety in preventing strictures in patients with mucosal defects no longer than 100 mm in length after esophageal cESD. The longitudinal length of ulceration > 60 mm was the independent factor for predicting stricture.

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Funding

The study was supported by Grants or donations from National Natural Science Foundation of China (Grant Nos.82100697 and 81270564).

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Author notes

  1. Longsong Li, Zixin Wang and Nanjun Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China

    Longsong Li, Zixin Wang, Nanjun Wang, Bo Zhang, Jiale Zou, Jingyuan Xiang, Chen Du, Ning Xu, Pengju Wang, Xiangyao Wang, Jiancong Feng, Enqiang Linghu & Ningli Chai

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  1. Longsong Li
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Contributions

Our research was mainly designed by NC and EL. All operations were operated by NC and EL. LL, ZW and NW devoted themselves to collecting data and follow-up. LL and ZW drafted the article. Analysis and interpretation: LL, ZW, NW, BZ, JZ, JX, CD, NX, PW, XW, JF. Critical revision of the article for important intellectual content: NC and EL. Final approval of the article: NC and EL.

Corresponding authors

Correspondence to Enqiang Linghu or Ningli Chai.

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Conflict of interest

Longsong Li, Zixin Wang, Nanjun Wang, Bo Zhang, Jiale Zou, Jingyuan Xiang, Chen Du, Ning Xu, Pengju Wang, Xiangyao Wang, Jiancong Feng, Enqiang Linghu and Ningli Chai have no conflicts of interest or financial ties to disclose.

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Li, L., Wang, Z., Wang, N. et al. Self-help inflatable balloon versus autologous skin-grafting surgery for preventing esophageal stricture after complete circular endoscopic submucosal dissection: a propensity score matching analysis. Surg Endosc 37, 3710–3719 (2023). https://doi.org/10.1007/s00464-022-09789-4

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