Risk stratification for stricture formation after endoscopic submucosal dissection for esophageal dysplasia

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Oncology

Background:

• Esophageal endoscopic submucosal dissection (ESD) is a minimally invasive technique for resecting early-stage esophageal neoplasms.
• Stricture formation is a significant complication following esophageal ESD, potentially leading to dysphagia and requiring interventions.
• Identifying factors associated with stricture development is crucial for optimizing patient management and outcomes.

Purpose of the Study:

• To evaluate demographic, clinical, procedural, and histopathologic factors associated with stricture development after esophageal ESD.
• To determine the incidence and characteristics of esophageal strictures post-ESD.
• To identify independent predictors of stricture formation following esophageal ESD.

Main Methods:

• Retrospective cohort study of patients undergoing esophageal ESD from 2019 to 2024.
• Data collection included patient demographics, lesion characteristics, procedural details, and histopathology.
• Stricture formation was defined as symptomatic luminal narrowing requiring intervention, with analysis of contributing factors and outcomes.

Main Results:

• Strictures developed in 24% of patients, with 85% being impassable for standard gastroscopes.
• Stricture rates significantly increased with greater defect circumferential involvement (7.7% for <50% to 57.7% for ≥90%).
• Independent predictors of stricture formation included defect circumferential involvement (OR 1.07), length of hospitalization (OR 1.88), and deep mural injury (OR 6.28).

Conclusions:

• Esophageal stricture formation post-ESD is strongly associated with lesion and procedural characteristics.
• Larger defect size, deep mural injury, and longer hospitalization are key predictors of stricture development.
• Further research into preventative strategies, including intraprocedural interventions like triamcinolone acetate injection and post-procedural steroid regimens, is warranted.