Endoscopy 2011; 43(3): 184-189
DOI: 10.1055/s-0030-1256109
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma

H.  Takahashi1 , Y.  Arimura2 , S.  Okahara1 , S.  Uchida1 , S.  Ishigaki1 , H.  Tsukagoshi1 , Y.  Shinomura2 , M.  Hosokawa3
  • 1Department of Gastroenterology, Keiyukai Sapporo Hospital, Sapporo, Japan
  • 2First Department of Internal Medicine, Sapporo Medical University, Sapporo, Japan
  • 3Department of Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
Further Information

Publication History

submitted 11 March 2010

accepted after revision 11 October 2010

Publication Date:
13 January 2011 (online)

Background and study aims: Growing evidence suggests that esophageal stricture frequently develops after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) in early esophageal cancer patients, with an incidence proportional to the greater extent of mucosal defects resulting from improved EMR/ESD techniques. There seems to be a potential risk of perforation during bougienage in such patients.

Patients and methods: 648 stricture dilations for 78 lesions in 76 patients were consecutively included. The outcomes after combined use of Maloney and Savary wire-guided bougienage for esophageal strictures after EMR/ESD were analyzed in a single-institute retrospective case series study. The perforation rate was determined and risk factors for perforation were identified.

Results: Patients underwent a median of 5.0 dilation procedures performed over a median 3.0 months for post-EMR/ESD strictures. Initial dilation was done a median 14 days following endoscopic resection. Perforations developed in seven patients (7/648 dilation procedures, 1.1 %), all in the lower esophagus, and bleeding occurred in one patient (0.1 % dilations). Two independent risk factors for development of perforation during dilation therapy for post-EMR/ESD stricture were identified: multiple dilations (odds ratio [OR] 1.2; P = 0.012), and lower site of stricture (OR 12.8; P = 0.043). Dysphagia was ameliorated by the dilations, and no patient required surgery.

Conclusions: A specific emerging risk of perforation in dilation therapy for post-EMR/ESD strictures was identified. Carefully planned treatment is necessary in patients with severe post-EMR/ESD strictures especially strictures requiring multiple dilations or located in the lower esophagus.

References

Y. ArimuraMD 

First Department of Internal Medicine, Sapporo Medical University

S-1, W-16, Chuo-ku
Sapporo 060-8543
Japan

Fax: +81-11-611-2282

Email: arimura@sapmed.ac.jp

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