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STEPWISE ESD CAN PREVENT SEVERE STRICTURE AFTER ESD FOR CIRCUMFERENTIAL ESOPHAGEAL TUMOR

Tsuneo Oyama 1, Akiko Takahashi 1

Affiliations

1 Saku Central Hospital Advanced Care Center, Nagano, Japan

Summary

AI Generated

Stepwise endoscopic submucosal dissection prevented post-procedure stricture in all seven patients with circumferential esophageal tumors, compared with 85% stricture rate in 55 en bloc resection patients.

None of the 7 patients in the stepwise ESD group required endoscopic balloon dilatation for stricture, versus 47 of 55 patients (85%) in the en bloc group who required a median of 5 dilatations.
Ulcer healing was significantly faster in the stepwise group at a median of 42 days compared with 137 days in the en bloc group (p<0.0001).
The stepwise group had smaller median tumor diameter (40 mm versus 59 mm) and shorter mucosal defect length (6 cm versus 8 cm), both statistically significant differences.
One perforation occurred during balloon dilatation in the en bloc group and was managed conservatively without surgery; no perforations or transfusion-requiring bleeding occurred during ESD in either group.
This retrospective study from a single hospital (2006-2022) included 62 patients with circumferential esophageal dysplasia or T1a-T1b cancer and may inform endoscopists managing similar cases.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

ESD is a standard treatment for Dysplasia or T1a esophageal cancers. However, severe stricture after circumferential ESD is a remaining major problem. Various managements have been reported, such as steroid injection, oral administration, and application of polyglycolic acid sheets, but none of them are sufficiently effective. Recently, the authors performed stepwise ESD in patients with circumferential esophageal cancers to prevent severe stricture after ESD.

Aims & Methods

The aim of this retrospective study is to clarify the usefulness of Stepwise ESD for preventing severe stricture after circumferential resection for esophageal tumor. Patients who underwent additional surgery due to the depth of SM2 or positive vascular invasion as a result of performing circumferential ESD were excluded from this study. Subjects were patients with circumferential esophageal tumors pathologically diagnosed as Vienna classification 4 or 5, who underwent ESD at Saku Hospital from 2006 to 2022. Sixteen and forty-six lesions were adenocarcinoma (EAC) and Squamous cell carcinoma (SCC), respectively. In the EAC group, the invasion depth was T1a in 9 cases and T1b in 1 case. In addition, the depth of invasion in the SCC group was T1a in 38 cases and T1b in 7 cases. The patients were divided into the En bloc (EB) group and the Stepwise (SW) group, and the background, number of endoscopic balloon dilatation (EBD), complications, etc. were examined for each group.

Results

Sixty-two patients, including 55 in the EB and 7 in the SW group, who required circumferential ESD, were entered into this study. There was no significant difference in age and gender between two groups.
Of the 55 patients in the EB group, 47 (85%) had severe stenosis and required EBD, but none in the SW group required EBD. The median number of EBDs was 5 (0-33) in the EB group and 0 (0-0) in the SW group.
And, the duration of ulcer healing in both groups were 137 (42-1028) days and 42 (30-120) days. The duration to healing of ESD ulcers was significantly shorter in the SW group (p<0.0001). The volume of TA injection were 50 (0-150) mg and 50 (0-100) mg, respectively. There was no significant difference (p=0.88).
The long axis mucosal defect lengths in the EB and SW groups were 8(5-15) cm and 6(3-9) cm, respectively. There was a significant difference between two groups (p=0.0004).
The diameters of the tumors were 59 (30-130) mm and 40 (36-64) mm, respectively. The length of resected specimen were 68 (29-150) mm and 56 (27-92) mm, respectively. There was a significant difference between two groups p=0.0004 and 0.0007.
Complications: There were no perforation and bleeding which needed blood transfusion. And, one patient in the EB group had a perforation during EBD, which could be cured with conservative treatment without surgery.

Conclusion

It has been reported that a circumference excision of 5 cm or more may cause severe stenosis. In this study, a median of 6 cm was performed even in the SW group, and stenosis could be prevented in all 7 cases. Therefore, Stepwise ESD may be a useful method to prevent post-ESD stricture in circumferential superficial esophageal tumors.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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