Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection

Chen, Meihong; Dang, Yini; Ding, Chao; Yang, Jiajia; Si, Xiaoyan; Zhang, Guoxin

doi:10.1007/s00464-020-07368-z

Cited by 26 publications

(23 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evidence of this study showed that more than 3/4 circumferential esophageal lumen, lesions near upper esophagus, postoperative fever and operation time were the independent risk factors of esophageal stricture after ESD. >3/4 luminal circumference was consistent with the vast majority of previous studies, while the conclusion of other three risk factor varied from literature to literature [7,13].…”

Section: Discussionsupporting

confidence: 89%

“…Multivariate logistic analysis revealed that more than 3/4 of the circumferential extension is a reliable risk factor [4]. But little consensus has been achieved in longitudinal resection length >50mm, the depth of in ltration more than lamina propria (m2), muscular injury and clip number and so on [5][6][7]. Postoperative symptoms and laboratory tests were seldom incorporated into models.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A nomogram to predict stricture after endoscopic submucosal dissection for early esophageal cancer

Xing

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Risk factors of esophageal stricture after ESD are inconsistent and incomprehensive, the present study aimed to identify a robust model to predict postoperative stricture.Methods: This retrospective study included 273 individuals underwent ESD for early esophageal cancer from January 1, 2014 to October 30, 2020 in Beijing Friendship Hospital. Univariate Cox proportional hazard regression was used to estimate potential factors of stricture after ESD, followed by multivariate Cox proportional hazard regression to identify significant independent predictors after adjusting for covariates. Nomogram building based on multivariate Cox regression model was used to evaluate accuracy and discrimination by ROC curves and calibration curves respectively.Results: Stricture was identified in 28 patients (10%). The other patients were enrolled in non-stricture group (n=243). Multivariate Cox proportional hazard model demonstrated that operation time (HR 1.01, 95%CI: 1.00-1.01, P<0.01), upper segment of esophagus (HR 6.48, 95%CI: 2.07-20.33, P<0.01), middle segment of esophagus (HR 3.42, 95%CI: 1.36-8.64, P<0.01), >3/4 circumferential lumen of esophagus (HR 6.32, 95%CI: 2.20-18.13, P<0.01), postoperative fever (HR 6.17, 95%CI: 1.75-21.77, P<0.01), were independent predictive factors for postoperative stricture. The predictive accuracy of the nomogram was estimated by the AUC of ROC curves was 0.93, 0.87, 0.87 at 1 year, 2 years, and 3 years respectively.Conclusion: Longer operation time, >3/4 of the circumferential lumen of esophagus, located at upper and middle esophageal segment, and postoperative fever were independent risk factors of esophageal stricture after ESD.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

A nomogram to predict stricture after endoscopic submucosal dissection for early esophageal cancer

Xing

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…The reported incidence of esophageal post-ESD stenosis is 7.1%–26.8%. [ 10 , 11 , 12 , 13 ] Symptomatic esophageal stenosis and repeated endoscopic dilatation impair patients’ quality of life and predispose them to psychiatric problems, including mood disorder and suicidality. [ 14 ]…”

Section: Introductionmentioning

confidence: 99%

Advances in the application of regenerative medicine in prevention of post-endoscopic submucosal dissection for esophageal stenosis

Wang

Zhao

Zhang

2022

Journal of Translational Internal Medicine

View full text Add to dashboard Cite

Endoscopic submucosal dissection (ESD) is a curative treatment for superficial esophageal cancer with distinct advantages. However, esophageal stenosis after ESD remains a tough problem, especially after large circumferential proportion of esophageal mucosa is removed, which limits the wide use of ESD, especially in circumferential lesions. In this scenario, preventive procedures are highly recommended against post-ESD esophageal stenosis. However, the efficacy and safety of traditional prophylactic methods (steroids, metal and biodegradable stents, balloon dilation, radial incision, etc.) are not satisfactory and novel strategies need to be developed. Regenerative medicine has been showing enormous potential in the reconstruction of organs including the esophagus. In this review, we aimed to describe the current status of regenerative medicine in prevention of post-ESD esophageal stenosis. Cell injection, cell sheet transplantation, and extracellular matrix implantation have been proved effective. However, numerous obstacles still exist and further studies are necessary.

show abstract

“…Endoscopic submucosal dissection (ESD) sets a standard for precancerous lesions, and early esophageal cancers (ECs) confined to the submucosa with a low risk of distant metastases (1,2).…”

Section: Introductionmentioning

confidence: 99%

Autologous esophageal mucosa with polyglycolic acid transplantation and temporary stent implantation can prevent stenosis after circumferential endoscopic submucosal dissection

Liu

Dou

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

Background: This research aimed at investigating the safety and efficacy of autologous esophageal mucosa (AEM) with polyglycolic acid (PGA) transplantation and temporary stent implantation (TSI) in preventing esophageal stenosis (ES) after early esophageal cancer (EC) surgery.Methods: Between April 2019 and October 2020, patients scheduled for circumferential endoscopic submucosal dissection (ESD) were prospectively recruited. After ESD, autologous esophageal mucosal patches (MPs) were constructed on the absorbable PGA felt. Then, the felt was structured onto a covered metal mesh stent (CMMS) and attached to the ulcer surface. The stents were removed 6-8 weeks after the operation. The occurrence of ES and adverse events was observed and analyzed.Results: Data from 25 patients were analyzed. In total, 14 patients (56%) had no stenosis during an average follow-up of 10.2 months, and 11 patients (44%) suffered strictures at a mean interval of 63.73 days after the ESD procedure. Stent migration occurred in 2 patients. No other complications, including perforations, bleeding, or wound infections, occurred. The median of endoscopic balloon dilatation (EBD) sessions was 2.16 (range, 0-14). There showed a higher post-ESD stricture rate in patients with lesions located in the middle-lower esophagus (P<0.05). More transplanted MPs may reduce the occurrence of ES.Conclusions: AEM with PGA transplantation and TSI is a safe and effective approach of preventing ES and improving the life quality after circumferential ESD.

show abstract

Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection

Cited by 26 publications

References 31 publications

A nomogram to predict stricture after endoscopic submucosal dissection for early esophageal cancer

A nomogram to predict stricture after endoscopic submucosal dissection for early esophageal cancer

Advances in the application of regenerative medicine in prevention of post-endoscopic submucosal dissection for esophageal stenosis

Autologous esophageal mucosa with polyglycolic acid transplantation and temporary stent implantation can prevent stenosis after circumferential endoscopic submucosal dissection

Contact Info

Product

Resources

About