Year 2021 / Volume 113 / Number 12
Original
Risk factors of refractory post-endoscopic submucosal dissection esophageal strictures

813-819

DOI: 10.17235/reed.2021.8061/2021

Enrique Pérez-Cuadrado Robles, Tom G. Moreels, Hubert Piessevaux, Ralph Yeung, Tarik Aouattah, Pierre H. Deprez,

Abstract
Introduction: our aim was to comparatively assess the treatment outcomes of endoscopic dilatation in Barrett’s neoplasia and squamous cell carcinoma (SCC) post-endoscopic submucosal dissection (ESD) strictures, and to determine the risk or factors associated to refractory strictures. Methods: an observational study. All consecutive patients presenting with a post-ESD stricture in 2007-2016 who underwent dilation therapy were included. Clinical, morphological, and technical features were assessed to determine the risk factors of refractory strictures. Results: of 414 consecutive patients treated by ESD, 83 (mean age: 65 ± 10 years, 76 % men) with 254 dilations (median: 3, range: 1-27) were considered. Barrett’s neoplasia and SCC were the indications in 58 (69.9 %) and in 25 (30.1 %) cases, respectively. Clinical success was achieved in 84.3 % with a median of 3 sessions (range: 1-22), with a higher rate in Barrett’s neoplasia (89.7 % vs. 72 %, p = 0.042). Circumferential resection in one single procedure (13.2 %) was associated with the need for a higher number of dilation sessions. By multivariate analysis, upper-esophageal location (OR: 11.479 [95 % CI: 2.058-64.043], p = 0.005), recurrent strictures (OR: 17.252 [95 % CI: 2.833-105.069], p = 0.002), and dilation-related complications (OR: 26.420 [95 % CI: 1.736-401.966], p = 0.018) were risk factors of refractory stenosis. Conclusion: patients presenting with SCC located in the upper superior esophagus, intra-procedural perforation, and recurrent strictures are at higher risk of developing refractory strictures.
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References
1. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015;47(9):829-54.
2. Sgourakis G, Gockel I, Lang H. Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol 2013;19(9):1424-37.
3. Deprez PH. Esophageal strictures after extensive endoscopic resection: hope for a better outcome? Gastrointest Endosc 2013;78(2):258-9.
4. Jain D, Singhal S. Esophageal Stricture Prevention after Endoscopic Submucosal Dissection. Clin Endosc 2016;49(3):241-56.
5. Sato H, Sagara S, Nakajima N, et al. Prevention of esophageal stricture after endoscopic submucosal dissection using RNA-based silencing of carbohydrate sulfotransferase 15 in a porcine model. Endoscopy 2017;49(5):491-7.
6. Wen J, Lu Z, Linghu E, et al. Prevention of esophageal strictures after endoscopic submucosal dissection with the injection of botulinum toxin type A. Gastrointest Endosc 2016;84(4):606-13.
7. Iizuka T, Kikuchi D, Yamada A, et al. Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma. Endoscopy 2015;47(4):341-4.
8. Kim GH, Jee SR, Jang JY, et al. Stricture occurring after endoscopic submucosal dissection for esophageal and gastric tumors. Clin Endosc 2014;47(6):516-22.
9. Nogales Ó, Clemente A, Caballero-Marcos A, et al. Endoscopically placed stents: a useful alternative for the management of refractory benign cervical esophageal stenosis. Rev Esp Enferm Dig 2017;109(7):510-5.
10. Zhang BZ, Zhang Y, Wang YD, et al. Stent placement to prevent strictures after esophageal endoscopic submucosal dissection: a systematic review and meta-analysis. Dis Esophagus 2021;34(9):doab015.
11. Tan Y, Liu D. Endoscopic incision for the treatment of refractory esophageal anastomotic strictures: outcomes of 13 cases with a minimum follow-up of 12 months. Rev Esp Enferm Dig 2016;108(4):196-200.
12. Merino Gallego E, Martinez Amate E, Gallego Rojo FJ. Incisional endoscopic therapy as a therapeutic alternative in esophageal anastomotic strictures refractory to conventional treatment. Rev Esp Enferm Dig 2019;111(9):717-9.
13. de Wijkerslooth LRH, Vleegaar FP, Siersema PD. Endoscopic management of difficult or recurrent esophageal strictures. Am J Gastroenterol 2011;106(12):2018-91; quiz 92.
14. Rodrigues-Pinto E, Pereira P, Ribeiro A, et al. Risk factors associated with refractoriness to esophageal dilatation for benign dysphagia. Eur J Gastroenterol Hepatol 2016;28(6):684-8.
15. Hanaoka N, Ishihara R, Uedo N, et al. Refractory strictures despite steroid injection after esophageal endoscopic resection. Endosc Int Open 2016;4(3):E354-9.
16. Chevaux JB, Piessevaux H, Jouret-Mourin A, et al. Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett's neoplasia. Endoscopy 2015;47(2):103-12.
17. Mavrogenis G, Hochberger J, Deprez P, et al. Technological review on endoscopic submucosal dissection: available equipment, recent developments and emerging techniques. Scand J Gastroenterol 2017;52(4):486-98.
18. Runge TM, Eluri S, Cotton CC, et al. Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy, and Persistence of the Fibrostenotic Phenotype. Am J Gastroenterol 2016;111(2):206-13.
19. Agarwalla A, Small AJ, Mendelson AH, et al. Risk of recurrent or refractory strictures and outcome of endoscopic dilation for radiation-induced esophageal strictures. Surg Endosc 2015;29(7):1903-12.
20. Kabbaj N, Salihoun M, Chaoui Z, et al. Safety and outcome using endoscopic dilatation for benign esophageal stricture without fluoroscopy. World J Gastrointest Pharmacol Ther 2011;2(6):46-9.
21. Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc 2005;62(3):474-5.
22. Hammad H, Kaltenbach T, Soetikno R. Endoscopic submucosal dissection for malignant esophageal lesions. Curr Gastroenterol Rep 2014;16(5):386.
23. Barret M, Beye B, Leblanc S, et al. Systematic review: the prevention of oesophageal stricture after endoscopic resection. Aliment Pharmacol Ther 2015;42(1):20-39.
24. Shi Q, Ju H, Yao LQ, et al. Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma. Endoscopy 2014;46(8):640-4.
25. Ono S, Fujishiro M, Niimi K, et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy 2009;41(8):661-5.
26. Na HK, Choi KD, Ahn JY, et al. Outcomes of balloon dilation for the treatment of strictures after endoscopic submucosal dissection compared with peptic strictures. Surg Endosc 2013;27(9):3237-46.
27. Takahashi H, Arimura Y, Okahara S, et al. Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma. Endoscopy 2011;43(3):184-9.
28. Hanaoka N, Ishihara R, Takeuchi Y, et al. Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy 2012;44(11):1007-11.
29. Hashimoto S, Kobayashi M, Takeuchi M, et al. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 2011;74(6):1389-93.
30. Kotani S, Shibagaki K, Yuki T, et al. A multicenter retrospective study of the esophageal triamcinolone acetonide-filling method in patients with extensive esophageal endoscopic submucosal dissection. Scand J Gastroenterol 2021;56(6):647-55.
31. Kataoka M, Anzai S, Shirasaki T, et al. Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer. Endosc Int Open 2015;3(2):E113-7.
32. Sato H, Inoue H, Kobayashi Y, et al. Control of severe strictures after circumferential endoscopic submucosal dissection for esophageal carcinoma: oral steroid therapy with balloon dilation or balloon dilation alone. Gastrointest Endosc 2013;78(2):250-7.
33. Yamaguchi N, Isomoto H, Nakayama T, et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 2011;73(6):1115-21.
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Pérez-Cuadrado Robles E, Moreels T, Piessevaux H, Yeung R, Aouattah T, Deprez P, et all. Risk factors of refractory post-endoscopic submucosal dissection esophageal strictures. 8061/2021


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Publication history

Received: 25/04/2021

Accepted: 09/09/2021

Online First: 14/09/2021

Published: 09/12/2021

Article revision time: 128 days

Article Online First time: 142 days

Article editing time: 228 days


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