Prediction of Esophageal Stricture after Endoscopic Submucosal Dissection in Patients with Early Esophageal Cancer

• Published in: Journal of gastrointestinal surgery Vol. 26; no. 12; pp. 2434 - 2443
• Main Authors: Zhou, Bo, Zhao, Zhe, Wang, Xing-Wei, Fan, Ling, Zhu, Jian-Ru, Yang, Ying-Ying, Zou, Pei-Ying, Chen, Dong-Feng, Shen, Xiao-Chun, Lan, Chun-Hui
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2022; Springer Nature B.V
• Subjects: Abdomen; Clinical practice guidelines; Constriction, Pathologic - etiology; Dissection; Endoscopic Mucosal Resection - adverse effects; Endoscopy; Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Stenosis - etiology; Gastroenterology; Gastrointestinal surgery; Humans; Iodine; Lymphatic system; Medical prognosis; Medicine; Medicine & Public Health; Mortality; Original Article; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Retrospective Studies; Risk factors; Surgery; Tumors; Endoscopic submucosal dissection (ESD); Esophageal stricture; Early esophageal cancer; Prediction
• DOI: 10.1007/s11605-022-05467-x
• ISSN: 1091-255X

Background Endoscopic submucosal dissection (ESD) treatment of early esophageal cancer is effective and safe. It is currently the first-line treatment for early esophageal cancer. However, a common side effect is the development of esophageal strictures after ESD. This study was designed to identify the risk factors for esophageal stricture development and to predict its occurrence after ESD. Methods In this retrospective study, 150 consecutive patients with early esophageal cancer treated with ESD at Daping Hospital, Chongqing, were enrolled between January 2016 and December 2020. Data on patient demographics, esophageal tumor characteristics, procedure-related factors, and postoperative situations were collected. We identified independent risk factors of esophageal stricture formation using univariate analysis and multivariate logistic regression. The predictive probability was obtained after multivariate logistic analysis. In addition, patients were divided into six groups based on these risk factors and the rate of esophageal stricture in each group was analyzed. Results The postoperative esophageal stricture rate was 14% (21/150). Tumor location (OR = 5.655, 95% CI: 1.245–25.691, P  = 0.025) and circumferential resection range (OR = 16.113, 95% CI: 4.294–60.466, P  < 0.001) are independent risk factors for the development of esophageal strictures. According to predictive probability analysis and the rates of stricture in six groups, we developed a possible flow chart to predict stricture formation. Conclusions Tumor location and circumferential resection range are reliable risk factors to predict the occurrence of esophageal strictures. Our prediction flow chart suggests that tumors with a circumferential resection range of 1/2–3/4 and located above the upper thoracic segment or a circumferential resection range of > 3/4 have a high risk of postoperative stricture. Thus, timely and effective preventive measures should be taken in these patients following ESD.