Mucosal defects linked to stenosis after endoscopic submucosal dissection

Last Updated: 2016-12-16

By Reuters Staff

NEW YORK (Reuters Health) - Large circumferential mucosal defects are associated with an increased risk of stenosis after endoscopic submucosal dissection (ESD) for colorectal neoplasms, researchers from Japan report.

Numerous reports have described the development of stenosis after ESD for lesions of the stomach and esophagus and its association with resection of more than 75% of the circumference. But there are few reports concerning the development of post-ESD stenosis in the colorectum.

Dr. Shin-ei Kudo and colleagues from Showa University Northern Yokohama Hospital investigated the incidence and risk factors of stenosis following colorectal ESD for 912 colorectal tumors in 822 patients.

During a median follow-up of 42 months, four patients (0.49%) developed post-ESD stenosis. All cases had circumferential mucosal defects >=90%.

In all four cases, the stenosis was membranous or less than 10 mm in length, and in three cases the stenosis resolved after one to three sessions of endoscopic balloon dilation (EBD), the researchers report in Gastrointestinal Endoscopy, online December 6.

The fourth case required steroidal therapy in addition to EBD, but none of the patients required surgery due to post-ESD stenosis.

"The results suggested that the circumferential extent of the mucosal defect was the most important risk factor of post-ESD stenosis in the colorectum," the researchers note. "In this study, post-ESD stenosis was limited within the cases in which the extent of the circumferential mucosal defect was >=90%."

"Our surveillance endoscopy policy (6 months after ESD) would be feasible in clinical practice and could spare unnecessary unscheduled colonoscopy and treatments of stenosis," they add. "Even if stenosis occurs after ESD for large colorectal neoplasms, it can be controlled successfully by a few sessions of EBD and/or steroid medication."

Dr. Kudo did not respond to a request for comments.

SOURCE: http://bit.ly/2gHWgzK

Gastrointest Endosc 2016.