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Independent risk factors for esophageal refractory stricture after extensive endoscopic submucosal dissection

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Abstract

Background

Endoscopic submucosal dissection (ESD) is accepted as a standard therapeutic technique for superficial esophageal neoplasms (SENs). However, esophageal refractory stricture is a serious adverse event secondary to extensive ESD (≥ 3/4 of the luminal circumference). This retrospective study aimed to investigate the risk factors for refractory postoperative stricture after extensive ESD.

Methods

The data of patients who underwent esophageal ESD at the Endoscopy Center of Changhai Hospital were reviewed between January 2011 and September 2019. Risk factors for postoperative refractory stricture [≥ 6 sessions of endoscopic balloon dilation (EBD)] after extensive ESD were then identified using univariate analysis and multivariate logistic regression analysis.

Results

A total of 69 SENs in 67 patients treated by extensive ESD were enrolled in this study. The refractory stricture incidence was 62% (43/69). Significant differences between non-refractory stricture group and refractory stricture group were observed in depth of infiltration (m1or m2/m3 or sm1:20/6 vs. 17/26, P = 0.003), longitudinal resection length (< 50 mm/ ≥ 50 mm:19/7 vs. 10/33, P < 0.001), circumferential range (3/4~ < 1/1:20/6 vs. 19/24, P = 0.008), muscular injury (NO/YES:18/8 vs. 19/24, P = 0.043), and clip number (≤ 5/ > 5:15/11 vs. 12/31, P = 0.014). Multivariate analysis revealed that longitudinal resection length ≥ 50 mm (odds ratio [OR] 11.099, 95% confidence interval [CI] 2.620–47.019), depth of infiltration above m2 (OR 5.716, 95%CI 1.324–24.672) and muscular injury happened (OR 4.431, 95%CI 1.052–18.659) were independent risk factors for refractory stricture. In addition, the EBD sessions for treatment of refractory stricture was related to longitudinal resection length (relation coefficient γ = 0.528; P  <0.05).

Conclusions

The longitudinal resection length, depth of tumor infiltration and muscular injury are the reliable risk factors for esophageal refractory stricture after extensive ESD.

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Acknowledgements

This work was supported by the National Nature Science Foundation of China (Nos. 81670604; 81772640; 81670585).

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Author notes

  1. Jian Tang, Fanyang Kong and Jun Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), 168 Changhai Road, Shanghai, 200433, China

    Jian Tang, Fanyang Kong, Jun Li, Xiangyu Kong & Zhaoshen Li

  2. Digestive Endoscopy Center, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Mid Yanchang Road, Shanghai, 200072, China

    Feng Liu

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  1. Jian Tang
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Contributions

Conception and design (ZL); analysis and interpretation of the data (JT, FK); drafting of the article (JT, JL); critical revision of the article for important intellectual content (JL, FL); study supervision (XK). The article has been approved by all authors to be published.

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Correspondence to Feng Liu, Xiangyu Kong or Zhaoshen Li.

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Drs. Jian Tang, Fanyang Kong, Jun Li, Feng Liu, Xiangyu Kong and Zhaoshen Li have no conflicts of interests or financial ties to disclose.

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Tang, J., Kong, F., Li, J. et al. Independent risk factors for esophageal refractory stricture after extensive endoscopic submucosal dissection. Surg Endosc 35, 3618–3627 (2021). https://doi.org/10.1007/s00464-020-07840-w

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  • DOI: https://doi.org/10.1007/s00464-020-07840-w

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