A multicenter retrospective study on the risk factors of stricture formation after moderate circumferential defect...

Endoscopic submucosal dissection (ESD) is an effective treatment for superficial esophageal cancer, but postoperative stenosis remains a considerable concern. Particularly, the probability of stenosis is less investigated in patients with a 50-75% circumferential mucosal defect. We identified the risk factors of postoperative stenosis after moderate circumferential defect resection in esophageal ESD.

This multicenter retrospective observational study analyzed data from 513 patients with 50-75% circumferential mucosal defect after esophageal ESD across 19 institutions from April 2018 to March 2022. The risk factors for postoperative esophageal stenosis, including steroid use, were investigated.

Postoperative stenosis was observed in 28 cases (5%). Multivariate analyses identified prior endoscopic treatment close to the lesion (odds ratio [OR], 5.10), cervical esophageal lesion (OR, 3.97), large circumferential defect (OR, 3.78), and longer procedural duration (OR, 3.83) as the independent risk factors for stenosis formation. In the sensitivity analysis using ridge-penalized logistic regression, only circumferential defect > 5/8 (OR, 3.30; 95% CI 1.56-7.66) and procedure time > 120 min (OR, 3.61; 95% CI 1.39-8.25) remained robust predictors; cervical location and prior endoscopic treatment were shrunk toward the null. Particularly, patients with a prior endoscopic treatment, a cervical esophageal lesion, and more than 5/8 of circumferential defect were likely to have stenosis postoperatively despite steroid use.

In patients with a 50-75% circumferential mucosal defect after esophageal ESD, steroids were used in > 40% of the patients, with 5% of the patients developing postoperative stenosis. Larger circumferential mucosal defect and longer procedural duration were considered as the most relevant risk factors. Stricture prevention should be more aggressively considered in cases at high-risk for stenosis, even though the mucosal defect area was less than three-fourth of the circumference.