Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan.
Clin Transl Gastroenterol. 2020 Aug;11(8):e00226. doi: 10.14309/ctg.0000000000000226.
Endoscopic submucosal dissection (ESD) could become a standard treatment for early stage esophageal neoplasia. Recurrence sometimes develops close to a previous ESD scar. These lesions are predictably difficult to treat with ESD because of severe fibrosis. We evaluated the clinical outcomes of ESD for esophageal neoplasia located close to a previous ESD scar.
This was a retrospective observational study in a single institution. A total of 549 consecutive patients with 927 esophageal lesions were treated with ESD. The primary outcomes were resectability and adverse events of esophageal neoplasia located close to previous ESD scars (ESD scar group) than in primary esophageal ESD (primary group). Furthermore, predictive factors of perforation were examined.
A total of 545 primary and 29 ESD scars in consecutive patients were evaluated. En bloc and complete (R0) resection rates in the ESD scar group were lower than those in the primary group (79.3% vs 98.3%, P < 0.01 and 75.9% vs 93.4%, P < 0.01). Perforations occurred more frequently in the ESD scar group (10.3% vs 2.0%, P = 0.03). The ESD scar group was a predictive factor for perforation (odds ratio = 10.37, 95% confidence interval: 2.15-49.94, P = 0.004). There were similar results for inverse probability of treatment weighting methods (odds ratio = 6.78, 95% confidence interval: 1.40-32.98, P = 0.018).
ESD for esophageal neoplasia located close to a previous ESD scar was difficult to completely resect and increased the likelihood of perforation but could be a treatment option.
内镜黏膜下剥离术（ESD）可能成为早期食管肿瘤的标准治疗方法。复发有时发生在先前 ESD 疤痕附近。由于严重纤维化，这些病变用 ESD 治疗预计会很困难。我们评估了 ESD 治疗靠近先前 ESD 疤痕的食管肿瘤的临床结果。
这是一项单中心回顾性观察研究。共对 549 例连续患者的 927 例食管病变进行了 ESD 治疗。主要结局是比较靠近先前 ESD 疤痕（ESD 疤痕组）和原发性食管 ESD（原发性组）的食管肿瘤的可切除性和不良事件。此外，还检查了穿孔的预测因素。
共评估了 545 例原发性和 29 例 ESD 疤痕的连续患者。ESD 疤痕组的整块和完全（R0）切除率低于原发性组（79.3%比 98.3%，P<0.01 和 75.9%比 93.4%，P<0.01）。ESD 疤痕组穿孔发生率较高（10.3%比 2.0%，P=0.03）。ESD 疤痕组是穿孔的预测因素（优势比=10.37，95%置信区间：2.15-49.94，P=0.004）。逆概率治疗加权方法也得到了类似的结果（优势比=6.78，95%置信区间：1.40-32.98，P=0.018）。
ESD 治疗靠近先前 ESD 疤痕的食管肿瘤难以完全切除，增加穿孔的可能性，但可能是一种治疗选择。
