Gut Liver.  2016 Sep;10(5):757-763. 10.5009/gnl15511.

Antral or Pyloric Deformity Is a Risk Factor for the Development of Postendoscopic Submucosal Dissection Pyloric Strictures

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. junchul75@yuhs.ac
  • 2Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
Surgeons must be aware of risk factors for strictures before performing endoscopic submucosal dissection (ESD), to enable early interventions to prevent severe strictures.
METHODS
This study was a single-center retrospective study. We reviewed the clinical data of patients who has undergone gastric ESD from January 2007 to December 2012.
RESULTS
Among the 3,819 patients who had undergone gastric ESD, 11 patients (7.2%) developed pyloric strictures and received successful endoscopic balloon dilation. Significant differences were noted between the patients without and with post-ESD strictures for pretreatment of antral or pyloric deformities (46.4% vs 81.8%), the proportion of extension to the lumen circumference (>3/4, 9.4% vs 54.5%), the longitudinal extent of mucosal defects (27.9±10.1 mm vs 51.5±10.8 mm), and post-ESD bleeding (2.9% vs 27.3%). Multivariate analysis revealed that pretreatment antral or pyloric deformities (odds ratio [OR], 30.53; 95% confidence interval [CI], 1.476 to 631.565; p=0.027), larger longitudinal extent of mucosal defects (OR, 1.20; 95% CI, 1.074 to 1.340; p=0.001), and circumferential extension of 3/4 (OR, 13.69; 95% CI, 1.583 to 118.387; p=0.017) were independent risk factors for post-ESD stricture.
CONCLUSIONS
Antral or pyloric deformities, sub-circumferential resection over more than 75% of the circumference and greater longitudinal extent of mucosal defects are independent risk factors for post-ESD stricture.

Keyword

Antral deformity; Pyloric deformity; Endoscopic submucosal dissection; Post-endoscopic submucosal dissection stricture

MeSH Terms

Aged
Constriction, Pathologic/etiology
Dilatation/methods
Endoscopic Mucosal Resection/*adverse effects
Female
Gastric Mucosa/surgery
Gastroscopy/*adverse effects
Humans
Male
Middle Aged
Postoperative Complications/*etiology/surgery
Pyloric Antrum/*pathology/surgery
Pyloric Stenosis/*etiology/surgery
Pylorus/*pathology/surgery
Retrospective Studies
Risk Factors
Treatment Outcome
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