Endoscopy 2009; 41(8): 661-665
DOI: 10.1055/s-0029-1214867
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms

S.  Ono1 , M.  Fujishiro1 , K.  Niimi1 , O.  Goto1 , S.  Kodashima1 , N.  Yamamichi1 , M.  Omata1
  • 1Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Further Information

Publication History

submitted1 February 2009

accepted after revision4 May 2009

Publication Date:
29 June 2009 (online)

Background and study aims: Although endoscopic submucosal dissection (ESD) is becoming accepted as an established treatment for superficial esophageal squamous cell neoplasms, the risks for developing postoperative stricture have not been elucidated.

Patients and methods: This was a retrospective study at a single institution. From January 2002 to October 2008, 65 patients with high-grade intraepithelial neoplasms (HGINs) or m2 carcinomas treated by ESD were enrolled. Predictors of postoperative stricture were investigated by comparing results from 11 patients who developed strictures with those from 54 patients who did not .

Results: Significant differences between the two groups were observed in longitudinal diameter (45.0 ± 15.9 mm vs. 31.5 ± 13.6 mm) and circumferential diameter (37.2 ± 8.6 mm vs. 26.8 ± 9.7 mm) of the resected specimens, and the proportion of extension to the whole circumference of the lumen (< 1 / 2/ > 1 / 2/ > 3 / 4 : 2 / 4 / 5 vs. 40 / 13 / 1), histologic depth (HGIN/m2 : 2 / 9 vs. 41 / 13), and procedure time (85.6 ± 42.8 minutes vs. 53.3 ± 30.1 minutes). Multivariate analysis revealed that circumferential extension of > 3 / 4 (odds ration [OR]: 44.2; 95 % confidence interval [CI]: 4.4 – 443.6) and histologic depth to m2 (OR: 14.2; 95 %CI: 2.7 – 74.2) are reliable risk factors. Subanalysis for each category by combinations of these risk factors revealed that patients with lesions in > 3 / 4 of the circumferential area were associated with a high rate of postoperative stricture. By contrast, patients with HGIN lesions in < 3 / 4 extension have no probability of postoperative strictures. Additionally, subanalysis of patients with m2 lesions in < 3 / 4 circumferential extension revealed that circumferential diameter can be a reliable predictor for postoperative stricture.

Conclusions: Circumferential extension and histologic depth are the reliable risk factors for postoperative strictures. In combination with circumferential diameter, we can perform effective and appropriate preventive balloon dilatations after esophageal ESD.

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M. FujishiroMD 

Department of Gastroenterology
Graduate School of Medicine
University of Tokyo

7-3-1, Hongo
Bunkyo
Tokyo
Japan

Fax: +81-3-58008806

Email: mtfujish-kkr@umin.ac.jp