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

Abstract

Background and aim: Endoscopic submucosal dissection (ESD) is used to treat early esophageal cancer and precancerous lesions. Patients undergoing ESD are prone to esophageal stenosis, which impairs therapeutic efficacy and quality of life. This retrospective study aimed to investigate the potential association between patient demographics and esophageal lesion characteristics with the risk of esophageal stenosis following ESD. Methods: For this retrospective study 190 consecutive patients who underwent ESD between January 2013 and January 2015 were recruited. Data on patient demographics, esophageal lesion-related factors, operation details, esophageal stenosis occurrence and measures taken to prevent or treat stricture were collected, and the normality of distribution of each indicator was assessed with a Kolmogorov–Smirnov test. Stenosis risk factors were then identified using univariate and multivariate logistic regression. Results: Post-ESD esophageal stenosis occurred in 51 cases. Multivariate logistic regression analysis was performed to identify independent risk factors. A history of EMR/ESD (OR = 4.185, 95% CI: 1.511–11.589), resection circumferential diameter (OR = 1.721, 95% CI: 1.135–2.610), non-en bloc resection (OR = 7.413, 95% CI: 2.398–22.921), submucosal infiltration (OR = 3.449, 95% CI: 1.014–11.734) and circumferential resection range (OR = 57.493, 95% CI: 17.236–191.782) were identified as independent risk factors for post-ESD esophageal stenosis. Spraying porcine fibrin adhesive on the resection bed reduced neither the incidence of postoperative stenosis nor the extent of postoperative dilation. Conclusion: Post-ESD esophageal stenosis is significantly related to size and circumferential range of lesion resection. EMR/ESD history, non-en bloc resection and submucosal infiltration may be additional risk factors.