Clinical feasibility of gastric endoscopic submucosal dissection in patients on glucocorticoids or immunomodulators: Propensity-score-matched study

Hiroki Fukuya; Eikichi Ihara; Yoichiro Iboshi; Yorinobu Sumida; Daisuke Yoshimura; Shohei Hamada; Taisuke Sasaki; Akito Ohkubo; Shuichi Itonaga; Hitoshi Homma; Ryota Okitsu; Akihisa Ohno; Mitsuru Esaki; Naohiko Harada

doi:10.1055/a-2733-1229

Endoscopy International Open, Table of Contents

CC BY 4.0 · Endosc Int Open 2025; 13: a27331229
DOI: 10.1055/a-2733-1229

Original article

Clinical feasibility of gastric endoscopic submucosal dissection in patients on glucocorticoids or immunomodulators: Propensity-score-matched study

Authors

Hiroki Fukuya

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Eikichi Ihara

³Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (Ringgold ID: RIN12923)
Yoichiro Iboshi

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Yorinobu Sumida

⁴Department of Gastroenterology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
Daisuke Yoshimura

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Shohei Hamada

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Taisuke Sasaki

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Akito Ohkubo

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Shuichi Itonaga

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Hitoshi Homma

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Ryota Okitsu

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Akihisa Ohno

⁵Faculty of Medicine, Graduate School of Medical Sciences, School of Medicine, Department of Medicine and Bioregulatory Science, Kyushu University, Fukuoka, Japan (Ringgold ID: RIN38305)
Mitsuru Esaki

⁵Faculty of Medicine, Graduate School of Medical Sciences, School of Medicine, Department of Medicine and Bioregulatory Science, Kyushu University, Fukuoka, Japan (Ringgold ID: RIN38305)
Naohiko Harada

¹Department of Gastroenterology, National Hospital Organisation Kyushu Medical Center, Fukuoka, Japan (Ringgold ID: RIN37085)

²Institute of Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

Abstract

Background and study aims

Evidence on gastric endoscopic submucosal dissection (ESD) under glucocorticoids or immunomodulators (GC/IM) is limited. We evaluated whether GC/IM use affects gastric ESD outcomes.

Patients and methods

We retrospectively analyzed 411 consecutive ESDs (April 2017-April 2022). GC/IM users (n = 32) were compared with controls (n = 379); 1:3 propensity-score matching yielded 27 vs 81 patients. The primary outcome was overall complications, defined as a composite of pain, fever, delayed bleeding, and delayed perforation. Secondary outcomes were each component, intra-procedure perforation, hospital stay, and use of symptom-directed treatments (analgesics, antipyretics, antibiotics).

Results

Overall complications were more frequent with GC/IM than controls (44.4% vs 21.0%; P = 0.024; relative risk [RR] 2.11, 95% confidence interval 1.16–3.84), driven by pain (40.7% vs 18.5%; P = 0.035) and fever (11.1% vs 1.2%; P = 0.047). Rates of major complications did not differ (delayed bleeding 3.7% vs 2.5%; delayed perforation 0% vs 0%). Intra-procedure perforation was numerically higher (7.4% vs 3.7%) without significance. Median (interquartile range) hospital stay showed a small, non-significant difference (9 [7–12] vs 8 [7–9] days; P = 0.064). Symptom management was used more often with GC/IM (analgesics 25.9% vs 3.7%, P = 0.002; antipyretics 7.4% vs 2.5%, P = 0.270; antibiotics 7.4% vs 3.7%, P = 0.597).

Conclusions

In patients receiving GC/IM, gastric ESD was associated with a higher incidence of minor, clinically managed events—chiefly pain and transient fever—whereas major complications remained uncommon. With close monitoring and prompt symptom-directed care, gastric ESD appeared clinically feasible, albeit with slightly greater resource use and observation time.

Keywords

Endoscopic ultrasonography - Gastric cancer - Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Quality and logistical aspects - Performance and complications

Bibliographical Record
Hiroki Fukuya, Eikichi Ihara, Yoichiro Iboshi, Yorinobu Sumida, Daisuke Yoshimura, Shohei Hamada, Taisuke Sasaki, Akito Ohkubo, Shuichi Itonaga, Hitoshi Homma, Ryota Okitsu, Akihisa Ohno, Mitsuru Esaki, Naohiko Harada. Clinical feasibility of gastric endoscopic submucosal dissection in patients on glucocorticoids or immunomodulators: Propensity-score-matched study. Endosc Int Open 2025; 13: a27331229.
DOI: 10.1055/a-2733-1229

Full Text

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