An Integrated Circumferential Proportion and Defect Length Index for Predicting Esophageal Stricture After ESD in...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Device Technology

Background:

• Endoscopic submucosal dissection (ESD) is a minimally invasive technique for resecting gastrointestinal neoplasms.
• Esophageal stricture is a common complication following large mucosal defect ESD.
• Accurate prediction of stricture risk is crucial for patient management.

Purpose of the Study:

• To compare the predictive performance of circumferential proportion, defect length, and the length-to-residual mucosal proportion (LRP) index for esophageal stricture post-ESD.
• To explore the utility of LRP in predicting stricture for defects exceeding 10 cm.

Main Methods:

• Retrospective analysis of 378 patients undergoing esophageal ESD.
• Comparison of predictive indicators using receiver operating characteristic (ROC) analysis.
• Subgroup analysis for defects >10 cm and multivariable logistic regression.

Main Results:

• Postoperative stricture occurred in 21.7% of patients.
• Circumferential proportion and LRP demonstrated superior predictive accuracy (AUC ~0.87) compared to defect length alone (AUC ~0.69).
• LRP showed the highest predictive value in defects >10 cm (AUC 0.913) and was independently associated with stricture risk.

Conclusions:

• The LRP index is a valuable tool for predicting esophageal stricture after ESD, comparable to circumferential proportion.
• LRP shows potential as an exploratory metric for managing long-segment esophageal defects.
• Further external validation of the LRP index is recommended.