Esophageal Motility after Extensive Circumferential Endoscopic Submucosal Dissection for Superficial Esophageal Cancer

Abstract

Background/Aims: Endoscopic submucosal dissection (ESD) for superficial esophageal cancer is sometimes extensive, and in our experience, patients not infrequently present with dysphagia after ESD even in the absence of esophageal stricture. The aim of this study was to evaluate esophageal motility using high-resolution manometry (HRM) in patients with and without dysphagia after extensive circumferential ESD. Methods: HRM was performed in a total of 52 patients who had undergone ESD for superficial esophageal cancer and a mucosal defect after ESD exceeded more than two-thirds of the esophageal circumference. The frequency and type of esophageal dysmotility and the relationship between esophageal motility and dysphagia were evaluated. Results: Esophageal dysmotility was observed in 13 patients (25%): jackhammer esophagus in 4, esophagogastric junction outflow obstruction in 4, absent contractility in 2, and distal esophageal spasm, ineffective esophageal motility, and fragmented peristalsis in 1 patient each. Of the 22 patients with dysphagia after ESD, 9 (41%) had esophageal dysmotility. Of the 30 patients without dysphagia after ESD, 4 (13%) had esophageal dysmotility. The relationship between dysmotility and dysphagia was significant (p = 0.025). Conclusions: Esophageal dysmotility exists in approximately one-quarter of patients after extensive circumferential ESD, which is associated with dysphagia in the absence of esophageal stricture.

Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

“…Meissner's plexus in the submucosal layer and Auerbach's plexus in the proper muscle layer are associated with esophageal peristalsis, and these can be damaged during ESD, impairing esophageal motility . In addition, Kuribayashi et al reported that esophageal ESD is associated with dysphagia in the absence of an esophageal stricture . Therefore, the esophageal diameter is not the only parameter for evaluating a stricture, and symptoms of dysphagia should be included when defining strictures.…”

“…7,24,25 In addition, Kuribayashi et al reported that esophageal ESD is associated with dysphagia in the absence of an esophageal stricture. 26 Therefore, the esophageal diameter is not the only parameter for evaluating a stricture, and symptoms of dysphagia should be included when defining strictures.…”

Hepatocyte Growth Factor Facilitates Esophageal Mucosal Repair and Inhibits the Submucosal Fibrosis in a Rat Model of Esophageal Ulcer

“…The results of esophageal submucosal fibrosis of our study may indicate the initial phase of fibrosis. The previous study reported that the fibrosis of muscularis propria associated with endoscopic submucosal resection remained even after re-epithelialization [54]. However, we could not measure fiberization localized to the muscularis propria, as the muscular layer structure at the experimental ulcers was unclear since we induced the esophageal ulcers by acetic acid which was applied to the serosa.…”

Very Delayed Perforation after Esophageal Endoscopic Submucosal Dissection and Intralesional Triamcinolone Injection

“…A case of esophageal perforation due to food bolus impaction occurring after esophageal ESD has previously been reported [ 11 ]. Several reports have also demonstrated that circumferential ESD may cause impairment of esophageal motility, especially subsequent to triamcinolone injection [ 14 , 15 ]. Esophageal motility and dysphagia after ESD were investigated using high-resolution manometry in these studies.…”