Risk factors and management for gastric stenosis after endoscopic submucosal dissection for gastric epithelial neoplasm

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 20; no. 4; pp. 690 - 698
• Main Authors: Sumiyoshi, Tetsuya, Kondo, Hitoshi, Minagawa, Takeyoshi, Fujii, Ryoji, Sakata, Kaho, Inaba, Kenichi, Kimura, Tomohiro, Ihara, Hideyuki, Yoshizaki, Naohito, Hirayama, Michiaki, Oyamada, Yumiko, Okushiba, Shunichi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.07.2017; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Balloon treatment; Bleeding; Cancer Research; Constriction, Pathologic; Endoscopic Mucosal Resection - adverse effects; Endoscopy; Female; Gastric cancer; Gastroenterology; Health risk assessment; Heart diseases; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Retrospective Studies; Risk Factors; Stenosis; Stomach Diseases - epidemiology; Stomach Diseases - etiology; Stomach Diseases - surgery; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Tumors; Endoscopic submucosal dissection (ESD); Prophylactic endoscopic balloon dilation; Endoscopic balloon dilation (EBD); Gastric stenosis; Early gastric cancer
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-016-0673-6

Background Only a few studies have reported treatment options for stenosis after endoscopic submucosal dissection (ESD) for gastric neoplasms. This study aimed to identify the risk factors for and evaluate the management of stenosis after ESD for gastric epithelial neoplasms in the cardia and antrum. Methods We retrospectively reviewed 1218 patients (1447 gastric epithelial neoplasms) who underwent ESD at Tonan Hospital from June 2004 to November 2015. Post-ESD stenosis was defined when a standard endoscope could not be passed through the site. Results Post-ESD stenosis occurred in 10 (21.3%) of the 47 cardia cases and 14 (3.2%) of the 432 antrum cases. A wide resection of more than three fourths of the circumferential extent was the sole significant risk factor related to post-ESD stenosis in both cardia and antrum. Prophylactic endoscopic balloon dilation (EBD) was performed in 3 of 10 patients with cardiac stenosis and 4 of 14 with antral stenosis. Post-EBD bleeding occurred in one cardia (10%) and one antrum (7.1%) case each and was endoscopically treated. Perforation during EBD occurred in two (14.3%) antrum cases, both of which required emergency open surgery. All complications were observed in patients with conventional EBD, and no complications were associated with prophylactic EBD. Conclusions A wide resection of more than three fourths of the circumferential extent was the significant risk factor for post-ESD stenosis in both cardia and antrum, and prophylactic EBD could be a promising procedure for the management of post-ESD stenosis.