Skip to main content
SpringerLink
Log in

Risk factors for complications after endoscopic treatment in Chinese patients with early esophageal cancer and precancerous lesions

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This study aimed to analyze the risk factors for complications after endoscopic treatment of early esophageal cancer and precancerous lesions and provides evidence for developing preventive measures against these complications.

Methods

The clinical data of patients with early esophageal cancer and precancerous lesions treated in the Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College from January 2009 to December 2015 were analyzed. The risk factors related to delayed bleeding, perforation, and stenosis were assessed.

Results

Of 459 patients, 15 (3.3%) had delayed bleeding, 16 (3.5%) had perforation, and 82 (17.9%) had stenosis. Conservative treatment was performed for patients with bleeding and perforation, and endoscopic dilation was performed to relieve stenosis. The independent risk factors for delayed bleeding were lesion size (OR = 1.51, P = 0.020), circumferential diameter [odds ratio (OR) = 1.24, P = 0.037]. The kind of operation method [endoscopic submucosal dissection (ESD)/cap-based endoscopic resection (EMR-Cap): OR = 15.38, P = 0.013) was the independent risk factor for perforation. The independent predictors of stenosis were circumferential diameter (OR = 1.58, P < 0.001), lesion in the neck (OR = 0.12, P = 0.003), and surgical time (OR = 1.02, P = 0.007).

Conclusion

Few complications occur after the endoscopic treatment of early esophageal cancer and precancerous lesions which can be treated by endoscopic and conservative medical therapies. Strict operational training is required for ESD treatment.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ciocirlan M, Lapalus MG, Hervieu V, Souquet JC, Napoleon B, Scoazec JY, Lefort C, Saurin JC, Ponchon T (2007) Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 39:24–29

    Article  CAS  Google Scholar 

  2. Shi Q, Zhong YS, Yao LQ, Zhou PH, Xu MD, Wang P (2011) Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc 74:1194–1200

    Article  Google Scholar 

  3. Libanio D, Pimentel-Nunes P, Dinis-Ribeiro M (2016) Complications of endoscopic resection techniques for upper gi tract lesions. Best Pract Res Clin Gastroenterol 30:735–748

    Article  CAS  Google Scholar 

  4. Peng LJ, Tian SN, Lu L, Chen H, Ouyang YY, Wu YJ (2015) Outcome of endoscopic submucosal dissection for early gastric cancer of conventional and expanded indications: Systematic review and meta-analysis. J Dig Dis 16:67–74

    Article  Google Scholar 

  5. Japan Esophageal S (2017) Japanese classification of esophageal cancer, 11th edition: Part i. Esophagus 14:1–36

    Article  Google Scholar 

  6. Isomoto H, Yamaguchi N, Minami H, Nakao K (2013) Management of complications associated with endoscopic submucosal dissection/ endoscopic mucosal resection for esophageal cancer. Dig Endosc 25(Suppl 1):29–38

    Article  Google Scholar 

  7. Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, Omata M (2009) Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 70:860–866

    Article  Google Scholar 

  8. Koh R, Hirasawa K, Yahara S, Oka H, Sugimori K, Morimoto M, Numata K, Kokawa A, Sasaki T, Nozawa A, Taguri M, Morita S, Maeda S, Tanaka K (2013) Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms. Gastrointest Endosc 78:476–483

    Article  Google Scholar 

  9. Okada K, Yamamoto Y, Kasuga A, Omae M, Kubota M, Hirasawa T, Ishiyama A, Chino A, Tsuchida T, Fujisaki J, Nakajima A, Hoshino E, Igarashi M (2011) Risk factors for delayed bleeding after endoscopic submucosal dissection for gastric neoplasm. Surg Endosc 25:98–107

    Article  Google Scholar 

  10. Matsumura T, Arai M, Maruoka D, Okimoto K, Minemura S, Ishigami H, Saito K, Nakagawa T, Katsuno T, Yokosuka O (2014) Risk factors for early and delayed post-operative bleeding after endoscopic submucosal dissection of gastric neoplasms, including patients with continued use of antithrombotic agents. BMC Gastroenterol 14:172

    Article  Google Scholar 

  11. Nakamura K, Honda K, Akahoshi K, Ihara E, Matsuzaka H, Sumida Y, Yoshimura D, Akiho H, Motomura Y, Iwasa T, Komori K, Chijiiwa Y, Harada N, Ochiai T, Oya M, Oda Y, Takayanagi R (2015) Suitability of the expanded indication criteria for the treatment of early gastric cancer by endoscopic submucosal dissection: Japanese multicenter large-scale retrospective analysis of short- and long-term outcomes. Scand J Gastroenterol 50:413–422

    Article  Google Scholar 

  12. Chen ZY, Yang YC, Liu LM, Liu XG, Li YI, Li LP, Hu X, Zhang RY, Song Y, Qin Q (2015) Comparison of the clinical value of multi-band mucosectomy versus endoscopic mucosal resection for the treatment of patients with early-stage esophageal cancer. Oncol Lett 9:2716–2720

    Article  CAS  Google Scholar 

  13. Teoh AY, Chiu PW, Yu Ngo DK, Wong SK, Lau JY, Ng EK (2010) Outcomes of endoscopic submucosal dissection versus endoscopic mucosal resection in management of superficial squamous esophageal neoplasms outside japan. J Clin Gastroenterol 44:e190–194

    Article  Google Scholar 

  14. Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, Saito D, Ono H (2008) Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection–an analysis of risk factors. Endoscopy 40:179–183

    Article  CAS  Google Scholar 

  15. Mukai S, Cho S, Nakamura S, Hatano Y, Kotachi T, Shimizu A, Matsuura G, Azakami T, Takaba A, Hamada T, Hirata K, Nakanishi T (2013) Postprocedural combined treatment using the coagulation plus artery-selective clipping (2c) method for the prevention of delayed bleeding after esd. Surg Endosc 27:1292–1301

    Article  Google Scholar 

  16. Hirasawa K, Sato C, Makazu M, Kaneko H, Kobayashi R, Kokawa A, Maeda S (2015) Coagulation syndrome: delayed perforation after colorectal endoscopic treatments. World J Gastrointest Endosc 7:1055–1061

    Article  Google Scholar 

  17. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH (2015) Endoscopic submucosal dissection: European society of gastrointestinal endoscopy (esge) guideline. Endoscopy 47:829–854

    Article  Google Scholar 

  18. Esaki M, Matsumoto T, Hirakawa K, Nakamura S, Umeno J, Koga H, Yao T, Iida M (2007) Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection. Endoscopy 39:41–45

    Article  CAS  Google Scholar 

  19. Pouw RE, van Vilsteren FG, Peters FP, Alvarez Herrero L, Ten Kate FJ, Visser M, Schenk BE, Schoon EJ, Peters FT, Houben M, Bisschops R, Weusten BL, Bergman JJ (2011) Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early barrett's neoplasia. Gastrointest Endosc 74:35–43

    Article  Google Scholar 

  20. Shimizu Y, Takahashi M, Yoshida T, Ono S, Mabe K, Kato M, Asaka M, Sakamoto N (2013) Endoscopic resection (endoscopic mucosal resection/ endoscopic submucosal dissection) for superficial esophageal squamous cell carcinoma: Current status of various techniques. Dig Endosc 25(Suppl 1):13–19

    Article  Google Scholar 

  21. Kakushima N, Fujishiro M, Kodashima S, Muraki Y, Tateishi A, Omata M (2006) A learning curve for endoscopic submucosal dissection of gastric epithelial neoplasms. Endoscopy 38:991–995

    Article  CAS  Google Scholar 

  22. Alvarez Herrero L, Pouw RE, van Vilsteren FG, ten Kate FJ, Visser M, Seldenrijk CA, van Berge Henegouwen MI, Weusten BL, Bergman JJ (2011) Safety and efficacy of multiband mucosectomy in 1060 resections in barrett's esophagus. Endoscopy 43:177–183

    Article  CAS  Google Scholar 

  23. Zhang YM, He S, Xue LY, Lv N, Cheng GY, Qin XM, Dou LZ, Lai SQ, Ni XG, Zhang L, Yu GX, Ju FH, Xun HY, Zhu N, Wang GQ (2012) comparative study of endoscopic mucous resection with transparent cap and endoscopic multi-band mucosectomy for early esophageal cancer and precancerous lesion. Zhonghua wei chang wai ke za zhi Chin J Gastrointest Surg 15:913–917

    Google Scholar 

  24. Maeda Y, Hirasawa D, Fujita N, Obana T, Sugawara T, Ohira T, Harada Y, Yamagata T, Suzuki K, Koike Y, Yamamoto Y, Kusaka Z, Noda Y (2012) A pilot study to assess mediastinal emphysema after esophageal endoscopic submucosal dissection with carbon dioxide insufflation. Endoscopy 44:565–571

    Article  CAS  Google Scholar 

  25. Larghi A, Waxman I (2007) State of the art on endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc Clin N Am 17(441–469):v

    Google Scholar 

  26. 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  Google Scholar 

  27. Shi Q, Ju H, Yao LQ, Zhou PH, Xu MD, Chen T, Zhou JM, Chen TY, Zhong YS (2014) Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma. Endoscopy 46:640–644

    Article  Google Scholar 

  28. 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 73:1115–1121

    Article  Google Scholar 

  29. 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  Google Scholar 

  30. 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  Google Scholar 

  31. Zhang Y, Bergman JJ, Xue L, He S, Lyu N, Fleischer DE, Weusten B, Dawsey SM, Dou L, Wang G (2015) preliminary study on efficacy of radiofrequency ablation combined with endoscopic resection for eradicating widespread early non-flat type esophageal squamous cell carcinoma. Zhonghua wei chang wai ke za zhi Chin J Gastrointest Surg 18:875–880

    Google Scholar 

  32. Miwata T, Oka S, Tanaka S, Kagemoto K, Sanomura Y, Urabe Y, Hiyama T, Chayama K (2016) Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Surg Endosc 30:4049–4056

    Article  Google Scholar 

  33. 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  Google Scholar 

  34. Ohki T, Yamato M, Ota M, Takagi R, Murakami D, Kondo M, Sasaki R, Namiki H, Okano T, Yamamoto M (2012) Prevention of esophageal stricture after endoscopic submucosal dissection using tissue-engineered cell sheets. Gastroenterology 143(582–588):e582

    Article  Google Scholar 

Download references

Funding

Sanming Project of Medicine in Shenzhen (Number: SZSM201911008); CAMS Innovation Fund for Medical Sciences (CIFMS) (Number: 2016-12 M-001, 2017-I2M-1–001, 2019- 12 M-2–004); National Key Research and Development Program of China (Number: 2016YFC1302800, 2018YFC1313103); PUMC Youth Fund and the Fundamental Research Funds for the Central Universities (Number: 2017320012).

Author information

Authors and Affiliations

  1. Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan, Chaoyang District, Beijing, 100021, China

    Xinying Yu, Yong Liu, Shun He, Yueming Zhang, Lizhou Dou, Xiao Liu & Guiqi Wang

  2. Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Liyan Xue & Ning Lu

Authors
  1. Xinying Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liyan Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shun He
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yueming Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lizhou Dou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ning Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Guiqi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guiqi Wang.

Ethics declarations

Disclosures

Xinying Yu, Yong Liu, Liyan Xue, Shun He, Yueming Zhang, Lizhou Dou, Xiao Liu, Ning Lu and Guiqi Wang have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, X., Liu, Y., Xue, L. et al. Risk factors for complications after endoscopic treatment in Chinese patients with early esophageal cancer and precancerous lesions. Surg Endosc 35, 2144–2153 (2021). https://doi.org/10.1007/s00464-020-07619-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07619-z

Keywords

Search

Navigation