Department of Gastroenterology, Zhujiang Hospital, The Second Affiliated Hospital of Southern Medical University, Guangzhou, China.
Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Clin Transl Gastroenterol. 2020 Aug;11(8):e00188. doi: 10.14309/ctg.0000000000000188.
Submucosal fibrosis greatly hinders the success of endoscopic submucosal dissection (ESD). This study determined ESD outcomes in patients with esophageal submucosal fibrosis and further explored the predictors.
We retrospectively analyzed 163 patients with superficial squamous esophageal neoplasia. The degree of submucosal fibrosis was classified as follows: F0, none; F1, mild; and F2, severe. ESD outcomes as a function of the degree of submucosal fibrosis and biopsy were determined. The potential predictors of submucosal fibrosis were analyzed.
En bloc resection, R0 resection, and procedure time were significantly different between the F0-F2 groups (P = 0.009, P = 0.002, and P < 0.001, respectively). Perforation and immediate bleeding rates of F2 were significantly higher than the F0/F1 groups (P < 0.001 and P < 0.001, respectively). However, the nonbiopsy group vs the biopsy group and the delayed ESD group (postbiopsy >21 days) vs the early ESD group (postbiopsy ≤21 days) showed no statistical differences regarding the en bloc resection, R0 resection, and ESD complications (all P > 0.05). Further analysis indicated that it was not the biopsy history and delayed ESD (both P > 0.05), rather submucosal invasion vs intramucosal tumor (odds ratio = 4.534, P = 0.003) and current smoker vs nonsmoker (odds ratio = 2.145, P = 0.043) were independent risk factors for endoscopic submucosal fibrosis.
Esophageal submucosal fibrosis was shown to be closely related to unsatisfactory ESD outcomes. Biopsy history and delayed ESD had no adverse effect on submucosal fibrosis and ESD outcomes. Submucosal invasion and current cigarette smoking were predictors of submucosal fibrosis.
黏膜下纤维化极大地阻碍了内镜黏膜下剥离术（ESD）的成功。本研究旨在确定伴有食管黏膜下纤维化患者的 ESD 结果，并进一步探讨其预测因素。
我们回顾性分析了 163 例浅表性食管鳞状上皮内肿瘤患者。黏膜下纤维化程度分为以下几类：F0 级，无；F1 级，轻度；F2 级，重度。根据黏膜下纤维化程度和活检情况确定 ESD 结果。分析黏膜下纤维化的潜在预测因素。
整块切除率、R0 切除率和手术时间在 F0-F2 组之间差异有统计学意义（P = 0.009、P = 0.002 和 P < 0.001）。F2 组穿孔和即刻出血率明显高于 F0/F1 组（P < 0.001 和 P < 0.001）。然而，非活检组与活检组、延迟 ESD 组（活检后 >21 天）与早期 ESD 组（活检后 ≤21 天）之间的整块切除率、R0 切除率和 ESD 并发症均无统计学差异（均 P > 0.05）。进一步分析表明，活检史和延迟 ESD 均不是影响因素（均 P > 0.05），而是黏膜下浸润与黏膜内肿瘤（比值比=4.534，P = 0.003）和现吸烟者与非吸烟者（比值比=2.145，P = 0.043）是内镜下黏膜下纤维化的独立危险因素。
食管黏膜下纤维化与 ESD 结果不佳密切相关。活检史和延迟 ESD 对黏膜下纤维化和 ESD 结果无不良影响。黏膜下浸润和吸烟是黏膜下纤维化的预测因素。
