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Prediction of Esophageal Stricture after Endoscopic Submucosal Dissection in Patients with Early Esophageal Cancer

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Endoscopic submucosal dissection (ESD) treatment of early esophageal cancer is effective and safe. It is currently the first-line treatment for early esophageal cancer. However, a common side effect is the development of esophageal strictures after ESD. This study was designed to identify the risk factors for esophageal stricture development and to predict its occurrence after ESD.

Methods

In this retrospective study, 150 consecutive patients with early esophageal cancer treated with ESD at Daping Hospital, Chongqing, were enrolled between January 2016 and December 2020. Data on patient demographics, esophageal tumor characteristics, procedure-related factors, and postoperative situations were collected. We identified independent risk factors of esophageal stricture formation using univariate analysis and multivariate logistic regression. The predictive probability was obtained after multivariate logistic analysis. In addition, patients were divided into six groups based on these risk factors and the rate of esophageal stricture in each group was analyzed.

Results

The postoperative esophageal stricture rate was 14% (21/150). Tumor location (OR = 5.655, 95% CI: 1.245–25.691, P = 0.025) and circumferential resection range (OR = 16.113, 95% CI: 4.294–60.466, P < 0.001) are independent risk factors for the development of esophageal strictures. According to predictive probability analysis and the rates of stricture in six groups, we developed a possible flow chart to predict stricture formation.

Conclusions

Tumor location and circumferential resection range are reliable risk factors to predict the occurrence of esophageal strictures. Our prediction flow chart suggests that tumors with a circumferential resection range of 1/2–3/4 and located above the upper thoracic segment or a circumferential resection range of > 3/4 have a high risk of postoperative stricture. Thus, timely and effective preventive measures should be taken in these patients following ESD.

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Acknowledgements

The authors thank all patients who participated in this study.

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Authors and Affiliations

  1. Department of Gastroenterology, Daping Hospital, The Army Medical University, Chongqing, China

    Bo Zhou, Zhe Zhao, Xing-Wei Wang, Ling Fan, Jian-Ru Zhu, Ying-Ying Yang, Pei-Ying Zou, Dong-Feng Chen, Xiao-Chun Shen & Chun-Hui Lan

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  1. Bo Zhou
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Contributions

The first three authors contributed equally to this work. C-H.L.: study conceptualization, study design, data interpretation, manuscript editing, and funding acquisition; X-C.S.: study design, acquisition of data, statistical analysis, and manuscript preparation; B.Z.: study design, acquisition of data, statistical analysis, and manuscript preparation; Z.Z. and X-W.W.: acquisition of data, follow-up of patients; L.F. and J-R.Z.: follow-up of patients and acquisition of data; P-Y.Z.: oversight of the statistical analyses; and D-F.C.: study supervision and coordination. All authors have read and approved the final manuscript.

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Correspondence to Xiao-Chun Shen or Chun-Hui Lan.

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Zhou, B., Zhao, Z., Wang, XW. et al. Prediction of Esophageal Stricture after Endoscopic Submucosal Dissection in Patients with Early Esophageal Cancer. J Gastrointest Surg 26, 2434–2443 (2022). https://doi.org/10.1007/s11605-022-05467-x

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