Stricture after endoscopic submucosal dissection for early gastric cancers and adenomas

Stricture is a complication that may occur after endoscopic submucosal dissection (ESD) of gastric neoplasms. The goal of the present study was to investigate the incidence, risk factors and management of gastric stricture after ESD.

The medical records of 308 patients who underwent ESD for gastric neoplasms were reviewed. Stricture is defined as having symptoms caused by an obstruction through which a 1-cm diameter endoscopic fiber cannot be passed.

Stricture was identified in six of 308 patients (1.9%). Three of the six lesions were located in the prepylorus, two cases in the antrum and one in the cardia. The mean longitudinal distance and the mean area of the resected specimens in the six cases with stricture (7.8 ± 2.0 cm, 34.0 ± 15.8cm(2) , respectively) was significantly larger than in those without stricture (4.5 ± 1.4cm, 12.7 ± 8.3cm(2) , respectively, P<0.01). The ratio of the resected circumference/whole circumference was 83.3±7.5% in those with stricture in comparison to 25.4 ± 16.3% in those without stricture (P<0.01). All six patients underwent endoscopic balloon dilations, and obtained relief from stricture. However, one patient experienced a gastric perforation and recovered following conservative therapy.

Sub-circumferential resection over 75% of the circumference by ESD in the prepylorus, antrum and cardia is a risk factor for the occurrence of stricture. Early intervention might be considered for this high-risk group to avoid a perforation during balloon dilation.