To investigate risk factors associated with difficult endoscopic submucosal dissection(ESD)for superficial esophageal lesions(operating time≥90 min, non-curative resection, esophageal perforation).

The medical records of 452 patients with single esophageal lesion who received ESD at Department of Gastroenterology, Subei People′s Hospital of Jiangsu Province from July 2015 to June 2019 were retrospectively reviewed, including gender, age, lesion site, endoscopic gross morphology, lesion diameter, circumference, operative period, preoperative pathology, postoperative pathology, operating time and perforation complication.The factors associated with ESD operating time, non-curative resection and perforation were analyzed by univariate analysis.Statistically significant factors were then included in Logistic regression analysis to look for independent risk factors leading to difficulties in ESD surgery.

The mean age of the patients was(66.47±7.59)years, and the mean operating time was(72.7±32.9)min.A total of 212 cases of high-grade intraepithelial neoplasia and 240 cases of squamous cell carcinoma were diagnosed by postoperative pathology.The rate of curative resection was 83.1%(375/452). Complications of perforation occurred in 9 cases.The lesions gross morphology, length, circumference, location and experience of operator were risk factors of difficult ESD for superficial esophageal lesions by univariate analysis.Multivariate analysis showed that typeⅡa+ Ⅱc/Ⅱc was an independent risk factor for operating time≥90 min(OR=2.689, P=0.003), non-curative resection(OR=2.238, P=0.009)and perforation(OR=1.928, P=0.042). Lesion length(>2 cm)was an independent risk factor for operating time≥90 min(OR=5.917, P<0.001). Circumferential lesion size(1/3-2/3 esophageal circumference)was an independent risk factor for operating time≥90 min(OR=2.733, P=0.019), and≥2/3 circumference was an independent risk factor for operating time≥90 min(OR=26.502, P<0.001)and non-curative resection(OR=4.174, P<0.001). The lesion located in the upper esophagus(OR=2.609, P=0.016)and the operator′s experience(OR=1.897, P=0.045)were independent risk factors for operating time≥90 min.

TypeⅡa+ Ⅱc/Ⅱc lesions, the lesion length(>2 cm), circumferential lesion size(>1/3 esophageal circumference), the lesion located in the upper esophagus and the operator′s experience were independent risk factors for difficult esophageal ESD procedures.