Muscular injury as an independent risk factor for esophageal stenosis after endoscopic submucosal dissection of esophageal squamous cell cancer

被引:14
作者
Geng, Zi-Han [1 ,2 ,3 ]
Zhu, Yan [1 ,2 ,3 ]
Li, Quan-Lin [1 ,2 ,3 ]
Fu, Pei-Yao [1 ,2 ,3 ]
Xiang, An-Yi [1 ,2 ,3 ]
Pan, Hai-Ting [1 ,2 ,3 ]
Xu, Mei-Dong [1 ,2 ,3 ]
Chen, Shi-Yao [1 ,2 ,3 ]
Zhong, Yun-Shi [1 ,2 ,3 ]
Zhang, Yi-Qun [1 ,2 ,3 ]
Ma, Li-Li [1 ,2 ,3 ]
Hu, Jian-Wei [1 ,2 ,3 ]
Cai, Ming-Yan [1 ,2 ,3 ]
Qin, Wen-Zheng [1 ,2 ,3 ]
Chen, Wei-Feng [1 ,2 ,3 ,4 ,5 ]
Zhou, Ping-Hong [1 ,2 ,3 ,4 ,5 ]
机构
[1] Fudan Univ, Zhongshan Hosp, Endoscopy Ctr, Shanghai, Peoples R China
[2] Fudan Univ, Zhongshan Hosp, Endoscopy Res Inst, Shanghai, Peoples R China
[3] Shanghai Collaborat Innovat Ctr Endoscopy, Shanghai, Peoples R China
[4] Fudan Univ, Zhongshan Hosp, Endoscopy Ctr, 180 Fenglin Rd, Shanghai 200032, Peoples R China
[5] Fudan Univ, Zhongshan Hosp, Endoscopy Res Inst, 180 FengLin Rd, Shanghai 200032, Peoples R China
基金
中国国家自然科学基金;
关键词
ACHALASIA PATIENTS; CARCINOMA; STRICTURE; RESECTION; ADENOCARCINOMA; PREVENTION; MYOTOMY; TUMORS;
D O I
10.1016/j.gie.2023.05.046
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aims: Stenosis after esophageal endoscopic submucosal dissection (ESD) has a high incidence, and muscular injury is an important risk factor for esophageal stenosis. Hence, this study aimed to classify muscular injury degrees and investigate their association with postoperative stenosis. Methods: This retrospective study included 1033 patients with esophageal mucosal lesions treated with ESD between August 2015 and March 2021. Demographic and clinical parameters were analyzed, and stenosis risk factors were identified using multivariate logistic regression. A novel muscular injury classification system was proposed and used to investigate the association between different muscular injury degrees and postoperative stenosis. Finally, a scoring system was established to predict muscular injury. Results: Of 1033 patients, 118 (11.4%) had esophageal stenosis. The multivariate analysis demonstrated that the history of endoscopic esophageal treatment, circumferential range, and muscular injury were significant risk factors for esophageal stenosis. Patients with type II muscular injuries tended to develop complex stenosis (n = 13 [36.1%], P < .05), and type II muscular injuries were more likely to predispose patients to severe stenosis than type I (73.3% and 92.3%, respectively). The scoring system showed that patients with high scores (3-6) were more likely to have muscular injury. The score model presented good discriminatory power in the internal validation (area under the receiver-operating characteristic curve, .706; 95% confidence interval, .645-.767) and goodness-of-fit in the Hosmer-Lemeshow test (P = .865). Conclusions: Muscular injury was an independent risk factor for esophageal stenosis. The scoring system demonstrated good performance in predicting muscular injury during ESD.
引用
收藏
页码:534 / +
页数:16
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