Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms

Abstract

BACKGROUNDAdverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation.AIMTo investigate the incidence and risk factors of the MWT during esophageal ESD.METHODSFrom June 2014 to July 2017, patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed. The clinicopathological characteristics of the patients were collected. Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD. The incidence of MWTs was determined, and the risk factors for MWT were then further explored.RESULTSA total of 337 patients with 373 lesions treated by ESD were analyzed. Twenty patients developed MWTs during ESD (5.4%). Multivariate analysis identified that female sex (OR = 5.36, 95%CI: 1.47-19.50, P = 0.011) and procedure time longer than 88.5 min (OR = 3.953, 95%CI: 1.497-10.417, P = 0.005) were independent risk factors for an MWT during ESD. The cutoff value of the procedure time for an MWT was 88.5 min (sensitivity, 65.0%; specificity, 70.8%). Seven of the MWT patients received endoscopic hemostasis. All patients recovered satisfactorily without surgery for the laceration.CONCLUSIONThe incidence of MWTs during esophageal ESD was much higher than expected. Although most cases have a benign course, fatal conditions may occur. We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.

Unexpected gastric perforation during endoscopic submucosal tunnel dissection for early circumferential esophageal cancer

“…Endoscopic submucosal dissection (ESD) has been widely accepted as an effective and minimally invasive treatment for superficial esophageal neoplasms. Mallory-Weiss tear (MWT) during esophageal ESD has been recognized as a possible complication, with an approximate incidence of 5.4 % according to Chen et al [1] Here, we report a very rare case in which Mallory-Weiss tear led to severe gastric perforation during esophageal ESD. An 82-year-old man was admitted for treatment of a circumferential superficial esophageal neoplasm (▶ Fig.…”

Mallory-Weiss syndrome from giant gastric trichobezoar: A case report

“…In the majority of cases, the disease arises as an upper gastrointestinal bleeding episode that generally stops spontaneously within 48 h[ 3 , 8 , 9 ]. In occasional cases, the hemorrhage requires endoscopic or surgical hemostasis[ 7 ]. Hiatal hernia, chronic nonsteroidal anti-inflammatory drug abuse, hyperemesis gravidarum, or repeated abdominal efforts are usually the more frequent predisposing factors, even if this condition may also appear in absence of any other pathology[ 5 ].…”

“…Therefore, MWS should be suspected when a hematemesis occurs during a vomiting episode in a patient without cirrhosis. Diagnosis is made by upper gastrointestinal endoscopy, which also presents the opportunity for convenient management of any active bleeding[ 7 ].…”

Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia

“…6 In our case, multiple lacerations also occurred at the lesser curvature of the gastric upper body and fornix. Chen et al 7 reported 20 cases (5.4%) of MWT detected during an esophageal ESD under general anesthesia, with only one case of MWT perforation. In addition, female sex and procedure time longer than 88.5 min were shown to be independent risk factors (odds ratio = 5.270 and 3.953, respectively) for MWT during esophageal ESD.…”