White coat status is a predictive marker for post-esophageal endoscopic submucosal dissection stricture: a retrospective study

Abstract

Background Steroid therapy is primarily used to prevent esophageal stricture after endoscopic submucosal dissection (ESD). However, esophageal stricture can still occur after preventive therapy, and the effect of preventive steroid therapy cannot be predicted before stricture formation. This study aimed to clarify the risk factors for esophageal stricture after preventive steroid therapy. Methods This was a retrospective study conducted at three institutions. From January 2011 to February 2018, 28 large-sized SENs in 26 patients who had a mucosal defect that involved more than three-quarters of the esophageal circumference were enrolled. We classified white coats on artificial ulcers after esophageal ESD into three groups (thin, moderately thick, thick) based on endoscopic images obtained on postoperative day 7. Results The white coat status on the artificial ulcer after ESD was a significant risk factor for post-ESD stricture ( p < 0.05). The stricture rates in patients with thin, moderately thick and thick white coats were 10.0, 36.4 and 85.7%, respectively. When thin and moderately thick white coats were combined, the stricture rate was 23.8%. The rate of stricture in lesions with thick white coats was significantly higher than that in patients with thin white coats or thin to moderately thick white coats ( p < 0.05). The multivariate analysis revealed that the white coat status was an independent factor related to esophageal stricture (odds ratio 13.70, 95% confidence interval 1.22–154.0; p = 0.034). Conclusions The thickness of the white coat is a useful marker for predicting the risk of post-ESD stricture and the effectiveness of preventive steroid therapy.

A new protective gel to facilitate ulcer healing in artificial ulcers following oesophageal endoscopic submucosal dissection: a multicentre, randomized trial

“…ESD has enabled the en bloc resection of large-sized superficial oesophageal neoplasms, but it carries the risk of causing oesophageal stricture, bleeding, and perforation 9 . Among them, stenosis is the main long-term complication of oesophageal ESD and can substantially impair the patient’s quality of life.…”

“…Oesophageal stricture can result in dysphagia, vomiting, weight loss, and a substantially reduced quality of life. To date, the circumferential extension of the artificial ulcer, longitudinal length of the mucosal defect, and histological depth have been reported to contribute to oesophageal stricture after ESD 7 – 9 .…”

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

“…Risk factors for postoperative stenosis include larger size of esophageal lesions (longitudinal length and circumferential percentage), invasion into submucosa, failure of en bloc resection, and intraoperative muscular injury. [ 11 , 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]…”

A new protective gel to facilitate ulcer healing in artificial ulcers following esophageal endoscopic submucosal dissection: A multicenter, randomized trial

“…Esophageal stricture can result in dysphagia, vomiting, weight loss, and a substantially reduced quality of life. Up to now, the circumferential extension of the arti cial ulcer, longitudinal length of the mucosal defect, and histological depth have been reported to contribute to esophageal stricture after ESD [7][8][9] . Endoscopic balloon dilatation, stent placement, oral steroids administration, and endoscopic steroid injection have been used prophylactically for stricture after ESD 10 .…”