Independent risk factors for esophageal refractory stricture after extensive endoscopic submucosal dissection

医学 内镜黏膜下剥离术 优势比 食管狭窄 单变量分析 球囊扩张 回顾性队列研究 食管癌 内科学 置信区间 外科 食管 耐火材料(行星科学) 胃肠病学 多元分析 气球 癌症 物理 天体生物学
作者
Jian Tang,Fanyang Kong,Jun Li,Feng Liu,Xiangyu Kong,Zhaoshen Li
出处
期刊:Surgical Endoscopy and Other Interventional Techniques [Springer Science+Business Media]
卷期号:35 (7): 3618-3627 被引量:18
标识
DOI:10.1007/s00464-020-07840-w
摘要

Endoscopic submucosal dissection (ESD) is accepted as a standard therapeutic technique for superficial esophageal neoplasms (SENs). However, esophageal refractory stricture is a serious adverse event secondary to extensive ESD (≥ 3/4 of the luminal circumference). This retrospective study aimed to investigate the risk factors for refractory postoperative stricture after extensive ESD. The data of patients who underwent esophageal ESD at the Endoscopy Center of Changhai Hospital were reviewed between January 2011 and September 2019. Risk factors for postoperative refractory stricture [≥ 6 sessions of endoscopic balloon dilation (EBD)] after extensive ESD were then identified using univariate analysis and multivariate logistic regression analysis. A total of 69 SENs in 67 patients treated by extensive ESD were enrolled in this study. The refractory stricture incidence was 62% (43/69). Significant differences between non-refractory stricture group and refractory stricture group were observed in depth of infiltration (m1or m2/m3 or sm1:20/6 vs. 17/26, P = 0.003), longitudinal resection length ( 5:15/11 vs. 12/31, P = 0.014). Multivariate analysis revealed that longitudinal resection length ≥ 50 mm (odds ratio [OR] 11.099, 95% confidence interval [CI] 2.620–47.019), depth of infiltration above m2 (OR 5.716, 95%CI 1.324–24.672) and muscular injury happened (OR 4.431, 95%CI 1.052–18.659) were independent risk factors for refractory stricture. In addition, the EBD sessions for treatment of refractory stricture was related to longitudinal resection length (relation coefficient γ = 0.528; P  <0.05). The longitudinal resection length, depth of tumor infiltration and muscular injury are the reliable risk factors for esophageal refractory stricture after extensive ESD.
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