Introduction In the East, oesophageal endoscopic submucosal dissection (ESD) has been adopted as the preferred treatment for oesophageal squamous high grade dysplasia (HGD) and early oesophageal cancer. We aim to assess the post oesophageal ESD stricture rate and its subsequent management in a regional tertiary referral centre.
Method Retrospective study from 01/01/2009 to 31/06/2016. Data was obtained from local database in a tertiary teaching hospital in Hong Kong, China. Demographics, diagnosis, endoscopic findings and subsequent management were analysed.
Results A total of 30 (23M:7F) oesophageal ESD were performed during the study period. The mean age was 66.5 years (SD 9.5y). The mean follow-up period was 947 days (SD 757d). 17 (56.7%) ESD was performed for squamous HGD; 8 (26.7%) for squamous cell carcinoma and 5 (16.6%) for leiomyoma of the oesophagus. The mean specimen maximum dimension was 35.8 mm (SD 15.5 mm) and the mean specimen minimum dimension was 25.3 mm (SD 12.0 mm). The mean specimen area was 947.1 mm2(SD757.6mm2). The overall stricture rate was 30.0% (9/30). The mean number of days taken to achieve endoscopic diagnosis of stricture was 33 days. ESD >3/4 of circumference (AUROC 0.754 (0.537–0.971) p=0.03), maximum specimen diameter (AUROC 0.865 (0.712–1) p=0.002), specimen area (AUROC 0.780 (0.577–0.984) p=0.016) were predictors of stricture formation. Using 34.5 mm as a cut off for specimen maximum diameter, the sensitivity and specificity for predicting stricture formation was 88.9% and 61.9% respectively. Using specimen area of 1143mm2 as a cut off, the sensitivity and specificity for predicting stricture formation was 66.7% and 85.7% respectively. Post ESD endoscopy number was significantly higher in patients with post ESD stricture; 9 vs 3 p=0.004. 8 (88.9%) of the 9 strictures were resolved at the time of follow-up. The mean number of endoscopic interventions required was 8 (SD 7.2). All patients required dilatation while 2 patients had additional triamcinolone injection and 1 had additional temporary stenting.
Conclusion Post oesophageal ESD stricture is common and its incidence increases with large size ESD. Although strictures lead to significantly increase in the number of endoscopic intervention, the vast majority of strictures resolves with standard endoscopic therapies. Further research is required to prevent post ESD strictures.
. Kobayashi S, et al. Prevention of esophageal strictures after endoscopic submucosal dissection. World J Gastroenterol. 2014; 20(31): 15098–15109.
Disclosure of Interest None Declared
- Endoscopic submucosal dissection