White coat status is a predictive marker for post-esophageal endoscopic submucosal dissection stricture: a retrospective study

• Published in: Esophagus : official journal of the Japan Esophageal Society Vol. 16; no. 3; pp. 258 - 263
• Main Authors: Takahashi, Keitaro, Fujiya, Mikihiro, Ueno, Nobuhiro, Saito, Takeshi, Sugiyama, Yuya, Murakami, Yuki, Iwama, Takuya, Sasaki, Takahiro, Ijiri, Masami, Tanaka, Kazuyuki, Sakatani, Aki, Ando, Katsuyoshi, Nomura, Yoshiki, Kashima, Shin, Goto, Mitsuru, Moriichi, Kentaro, Okumura, Toshikatsu
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.07.2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Biomarkers; Case-Control Studies; Clinical Decision Rules; Constriction, Pathologic - pathology; Endoscopic Mucosal Resection - methods; Endoscopy; Endoscopy, Digestive System - methods; Esophageal Mucosa - abnormalities; Esophageal Mucosa - surgery; Esophageal Stenosis - etiology; Esophageal Stenosis - prevention & control; Esophageal Stenosis - surgery; Esophagus; Esophagus - diagnostic imaging; Esophagus - pathology; Esophagus - surgery; Female; Gastroenterology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original; Original Article; Postoperative Period; Retrospective Studies; Risk Factors; Steroids - therapeutic use; Surgical Oncology; Thoracic Surgery; Ulcer - pathology; Ulcer - surgery; Prevention; Endoscopic submucosal dissection; Esophageal stricture; White coat; Prediction
• ISSN: 1612-9059; 1612-9067
• DOI: 10.1007/s10388-019-00659-y

Background Steroid therapy is primarily used to prevent esophageal stricture after endoscopic submucosal dissection (ESD). However, esophageal stricture can still occur after preventive therapy, and the effect of preventive steroid therapy cannot be predicted before stricture formation. This study aimed to clarify the risk factors for esophageal stricture after preventive steroid therapy. Methods This was a retrospective study conducted at three institutions. From January 2011 to February 2018, 28 large-sized SENs in 26 patients who had a mucosal defect that involved more than three-quarters of the esophageal circumference were enrolled. We classified white coats on artificial ulcers after esophageal ESD into three groups (thin, moderately thick, thick) based on endoscopic images obtained on postoperative day 7. Results The white coat status on the artificial ulcer after ESD was a significant risk factor for post-ESD stricture ( p  < 0.05). The stricture rates in patients with thin, moderately thick and thick white coats were 10.0, 36.4 and 85.7%, respectively. When thin and moderately thick white coats were combined, the stricture rate was 23.8%. The rate of stricture in lesions with thick white coats was significantly higher than that in patients with thin white coats or thin to moderately thick white coats ( p  < 0.05). The multivariate analysis revealed that the white coat status was an independent factor related to esophageal stricture (odds ratio 13.70, 95% confidence interval 1.22–154.0; p  = 0.034). Conclusions The thickness of the white coat is a useful marker for predicting the risk of post-ESD stricture and the effectiveness of preventive steroid therapy.