Risk factors of esophageal stricture after endoscopic submucosal dissection for early esophageal carcinoma and intraepithelial neoplasia

doi:10.3877/cma.j.issn.2095-2015.2023.06.004

Abstract

Abstract:

Objective

To explore the risk factors of stenosis after endoscopic submucosal dissection(ESD)for early esophageal cancer and intraepithelial neoplasia, and to provide basis for clinical prevention and treatment of stenosis.

Methods

From January 2015 to December 2020, 155 patients with early esophageal cancer and intraepithelial neoplasia treated with ESD in the 960th Hospital of the PLA Joint Logistics Support Force were retrospectively analyzed.The general data, lesion characteristics, operation and the occurrence of esophageal stricture were collected, and the risk factors of stricture after ESD were analyzed by univariate and multivariate Logistic regression.

Results

Of 155 patients, esophageal stricture occurred in 23 patients(14.8%). Multivariate analysis showed that esophageal stricture after ESD was significantly correlated with circumferential lesion area>3/4, tumor invasion depth m3-sm1, lesion longitudinal diameter≥50 mm and esophageal endoscopic mucosal resection(EMR)/ESD history.

Conclusion

The independent risk factors of esophageal stricture after ESD are circumferential lesion area>3/4, depth of tumor invasion m3-sm1, longitudinal diameter of lesion≥50 mm and history of esophageal EMR/ESD.

Key words: Esophageal cancer, Intraepithelial neoplasia, Endoscopic submucosal dissection, Esophageal stricture, Risk factors

Chao Hou, Meichen Pan, Wenming Wu, Xingguang Huang, Xiang Li, Lingxue Cheng, Yuxuan Zhu, Wenbo Li. Risk factors of esophageal stricture after endoscopic submucosal dissection for early esophageal carcinoma and intraepithelial neoplasia[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 383-387.

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Figures/Tables 5

References 21

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组别	例数	性别		年龄(岁，±s)	吸烟史		饮酒史		高血压史
组别	例数	女	男	年龄(岁，±s)	否	有	否	有	否	有
非狭窄组	132	37/48(77.08)	95/107(88.79)	62.94±7.416	72/84(85.71)	60/71(84.51)	72/88(81.82)	60/67(89.55)	108/128(84.38)	24/27(88.89)
狭窄组	23	11/48(22.92)	12/107(11.21)	63.26±7.887	12/84(14.29)	11/71(15.49)	16/88(18.18)	7/67(10.45)	20/128(15.63)	3/27(11.11)
t/χ²值		3.59		－0.19	0.044		1.801		0.36
P值		0.058		0.848	0.833		0.185		0.549
组别	例数	心脏病史		糖尿病史		内镜黏膜切除术/内镜黏膜下剥离术病史		食管癌家族史
组别	例数	否	有	否	有	否	有	否	有
非狭窄组	132	121/141(85.82)	11/14(78.57)	125/147(85.03)	7/8(87.50)	118/132(89.39)	9/23(39.13)	22/143(15.38)	1/12(8.33)
狭窄组	23	20/141(14.18)	3/14(21.43)	22/147(14.87)	1/8(12.50)	14/132(10.60)	14/23(60.87)	121/143(84.62)	11/12(91.67)
t/χ²值		0.529		0.037		12.611		0.436
P值		0.467		0.848		<0.001		0.509

组别	例数	性别		年龄(岁，±s)	吸烟史		饮酒史		高血压史
组别	例数	女	男	年龄(岁，±s)	否	有	否	有	否	有
非狭窄组	132	37/48(77.08)	95/107(88.79)	62.94±7.416	72/84(85.71)	60/71(84.51)	72/88(81.82)	60/67(89.55)	108/128(84.38)	24/27(88.89)
狭窄组	23	11/48(22.92)	12/107(11.21)	63.26±7.887	12/84(14.29)	11/71(15.49)	16/88(18.18)	7/67(10.45)	20/128(15.63)	3/27(11.11)
t/χ²值		3.59		－0.19	0.044		1.801		0.36
P值		0.058		0.848	0.833		0.185		0.549
组别	例数	心脏病史		糖尿病史		内镜黏膜切除术/内镜黏膜下剥离术病史		食管癌家族史
组别	例数	否	有	否	有	否	有	否	有
非狭窄组	132	121/141(85.82)	11/14(78.57)	125/147(85.03)	7/8(87.50)	118/132(89.39)	9/23(39.13)	22/143(15.38)	1/12(8.33)
狭窄组	23	20/141(14.18)	3/14(21.43)	22/147(14.87)	1/8(12.50)	14/132(10.60)	14/23(60.87)	121/143(84.62)	11/12(91.67)
t/χ²值		0.529		0.037		12.611		0.436
P值		0.467		0.848		<0.001		0.509

组别	例数	病变部位			浸润深度		术后病理			病变环周范围
组别	例数	上段	中段	下段	m1~m2	m3~sm1	低瘤	高瘤	鳞癌	<1/2	1/2~3/4	>3/4
非狭窄组	132	82/92(89.13)	46/58(79.31)	4/5(80.00)	100/111(90.09)	32/44(72.73)	30/30(100.00)	56/64(87.50)	46/61(75.41)	44/46(95.65)	46/55(83.64)	42/54(77.78)
狭窄组	23	10/92(10.87)	12/58(20.69)	1/5(20.00)	11/111(9.91)	12/44(27.27)	0/30(0)	8/64(12.50)	15/61(24.59)	2/46(4.35)	9/55(16.36)	12/54(22.22)
t/χ²值		2.824			7.517		10.094			6.437
P值		0.244			0.006		0.229			0.04

组别	例数	病变部位			浸润深度		术后病理			病变环周范围
组别	例数	上段	中段	下段	m1~m2	m3~sm1	低瘤	高瘤	鳞癌	<1/2	1/2~3/4	>3/4
非狭窄组	132	82/92(89.13)	46/58(79.31)	4/5(80.00)	100/111(90.09)	32/44(72.73)	30/30(100.00)	56/64(87.50)	46/61(75.41)	44/46(95.65)	46/55(83.64)	42/54(77.78)
狭窄组	23	10/92(10.87)	12/58(20.69)	1/5(20.00)	11/111(9.91)	12/44(27.27)	0/30(0)	8/64(12.50)	15/61(24.59)	2/46(4.35)	9/55(16.36)	12/54(22.22)
t/χ²值		2.824			7.517		10.094			6.437
P值		0.244			0.006		0.229			0.04

组别	例数	整块切除		术后发热		病变纵行长径
组别	例数	否	有	否	有	<50 mm	≥50 mm
非狭窄组	132	1/2(50.00)	131/153(85.62)	112/129(86.82)	20/26(76.92)	96/104(92.31)	36/51(70.59)
狭窄组	23	1/2(50.00)	22/153(14.38)	17/129(13.18)	6/26(23.08)	8/104(7.69)	15/51(29.41)
t/χ²值		1.982		1.678		12.774
P值		0.213		0.201		<0.001

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