广泛内镜黏膜下剥离术后食管难治性狭窄的独立危险因素。
Independent risk factors for esophageal refractory stricture after extensive endoscopic submucosal dissection.
机构信息
Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), 168 Changhai Road, Shanghai, 200433, China.
Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Mid Yanchang Road, Shanghai, 200072, China.
出版信息
Surg Endosc. 2021 Jul;35(7):3618-3627. doi: 10.1007/s00464-020-07840-w. Epub 2020 Aug 3.
BACKGROUND
Endoscopic submucosal dissection (ESD) is accepted as a standard therapeutic technique for superficial esophageal neoplasms (SENs). However, esophageal refractory stricture is a serious adverse event secondary to extensive ESD (≥ 3/4 of the luminal circumference). This retrospective study aimed to investigate the risk factors for refractory postoperative stricture after extensive ESD.
METHODS
The data of patients who underwent esophageal ESD at the Endoscopy Center of Changhai Hospital were reviewed between January 2011 and September 2019. Risk factors for postoperative refractory stricture [≥ 6 sessions of endoscopic balloon dilation (EBD)] after extensive ESD were then identified using univariate analysis and multivariate logistic regression analysis.
RESULTS
A total of 69 SENs in 67 patients treated by extensive ESD were enrolled in this study. The refractory stricture incidence was 62% (43/69). Significant differences between non-refractory stricture group and refractory stricture group were observed in depth of infiltration (m1or m2/m3 or sm1:20/6 vs. 17/26, P = 0.003), longitudinal resection length (< 50 mm/ ≥ 50 mm:19/7 vs. 10/33, P < 0.001), circumferential range (3/4~ < 1/1:20/6 vs. 19/24, P = 0.008), muscular injury (NO/YES:18/8 vs. 19/24, P = 0.043), and clip number (≤ 5/ > 5:15/11 vs. 12/31, P = 0.014). Multivariate analysis revealed that longitudinal resection length ≥ 50 mm (odds ratio [OR] 11.099, 95% confidence interval [CI] 2.620-47.019), depth of infiltration above m2 (OR 5.716, 95%CI 1.324-24.672) and muscular injury happened (OR 4.431, 95%CI 1.052-18.659) were independent risk factors for refractory stricture. In addition, the EBD sessions for treatment of refractory stricture was related to longitudinal resection length (relation coefficient γ = 0.528; P <0.05).
CONCLUSIONS
The longitudinal resection length, depth of tumor infiltration and muscular injury are the reliable risk factors for esophageal refractory stricture after extensive ESD.
背景
内镜黏膜下剥离术（ESD）被认为是治疗表浅性食管肿瘤（SENs）的标准治疗技术。然而，广泛 ESD（≥1/4 管腔周长）后食管难治性狭窄是一种严重的不良事件。本回顾性研究旨在探讨广泛 ESD 后难治性术后狭窄的危险因素。
方法
回顾 2011 年 1 月至 2019 年 9 月在长海医院内镜中心行食管 ESD 的患者资料。采用单因素分析和多因素 logistic 回归分析，确定广泛 ESD 后难治性狭窄（≥6 次内镜球囊扩张术[EBD]）的术后危险因素。
结果
本研究共纳入 67 例患者的 69 个 SENs 行广泛 ESD 治疗。难治性狭窄发生率为 62%（43/69）。非难治性狭窄组和难治性狭窄组在浸润深度（m1 或 m2/m3 或 sm1：20/6 与 17/26，P=0.003）、纵向切除长度（<50mm/≥50mm：19/7 与 10/33，P<0.001）、环周范围（3/4~<1/1：20/6 与 19/24，P=0.008）、肌肉损伤（NO/YES：18/8 与 19/24，P=0.043）和夹数量（≤5/>5：15/11 与 12/31，P=0.014）方面存在显著差异。多因素分析显示，纵向切除长度≥50mm（比值比[OR]11.099，95%置信区间[CI]2.620-47.019）、浸润深度超过 m2（OR 5.716，95%CI 1.324-24.672）和发生肌肉损伤（OR 4.431，95%CI 1.052-18.659）是难治性狭窄的独立危险因素。此外，难治性狭窄的 EBD 治疗次数与纵向切除长度有关（相关系数γ=0.528；P<0.05）。
结论
纵向切除长度、肿瘤浸润深度和肌肉损伤是广泛 ESD 后食管难治性狭窄的可靠危险因素。
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