ABSTRACT
Objective:
To investigate the characteristics, process, and
prognosis of
esophageal stricture after circumferential
endoscopic submucosal dissection (ESD), and to preliminarily analyze the prevention and
treatment effects of simple
dilation,
stent placement, mucosal
transplantation, and
glucocorticoid (hereinafter referred to as
hormone) application in
esophageal stricture.
Methods:
From August 2017 to March 2022, at the First Affiliated
Hospital of Zhengzhou
University, the clinical and follow-up data of 55
patients who underwent circumferential ESD for early
esophageal cancer and precancerous lesions were retrospectively analyzed. According to the prevention and
treatment methods for
esophageal stricture, the
patients were divided into two groups simple
dilation group (23 cases) and combined
dilation group (32 cases). The combined
dilation group was divided into mucosal
transplantation subgroup (9 cases),
stent placement subgroup (14 cases),
hormone application subgroup (7 cases), and
bleomycin subgroup (2 cases, excluded from comparative
analysis due to limited cases). Overall
prognosis of
patients was observed.
Treatment efficacy,
prognosis, and adverse events were compared among the simple
dilation group, mucosal
transplantation subgroup,
stent placement subgroup, and
hormone application subgroup. Independent samples t-
test, chi-square test, and Fisher′s exact test were used for
statistical analysis.
Results:
Among the 55
patients, the follow-up
time was (894.1±417.7) days. Refractory
esophageal stricture (total
dilation times ≥ 5) occurred in 33
patients (60.0%). Fifty-two
patients (94.5%) achieved clinical remission of the
stricture. The total number of
dilations was 5.8±4.0, and the average
dysphagia-free period was (52.3±37.1) days. The
dysphagia-free period of mucosal
transplantation subgroup was longer than that of the simple
dilation group,
stent placement subgroup, and
hormone application subgroup ((114.5±50.0) days vs. (40.9±20.0), (39.7±10.0), and (40.9±25.5) days, respectively), and the differences were statistically significant ( t=4.82, 3.77 and 3.14, P<0.001, =0.011, =0.009). There were no statistically significant differences between the simple
dilation group and the mucosal
transplantation subgroup,
stent placement subgroup, and
hormone application subgroup in the total number of
dilations (6.8±4.8 vs. 3.0±2.5, 5.8±2.2, and 5.7±5.0),
stricture remission rate (95.7%, 22/23 vs. 8/9, 13/14, and 7/7), and
incidence of adverse events (17.4%, 4/23 vs. 5/9, 5/14, and 2/7; all P>0.05).
Conclusions:
Esophageal stricture formed after circumferential ESD shows the characteristics of
recurrence and intractability. The over all number of
dilations is high, and the average
dysphagia-free period is short. Most
patients can achieve clinical remission of the
stricture after multiple times of endoscopic
dilation treatment. However mucosal
transplantation,
stent placement, and
hormone application cannot well intervene the natural process of
esophageal stricture.