MANAGEMENT OF STRICTURES AFTER ENDOSCOPIC RESECTION FOR EARLY ESOPHAGEAL NEOPLASIA

Aims Most available data on the management of post endoscopic resection strictures involve Japanese patients. Our study aims to describe the management of post endoscopic esophageal strictures following endoscopic submucosal dissection (ESD) or mucosal resection (EMR) for early esophageal cancers at a Western center.

Methods Consecutive patients with endoscopic resection (ESD or EMR) for early esophageal cancer followed by endoscopic dilatation between January 2010 and September 2019 were identified from a prospectively maintained database including all therapeutic endoscopy procedures at our tertiary referal center. The demographic, endoscopic and histological characteristics of these patients were collected, as well as treatment outcomes.

Results During the study period, 161 EMR and 248 ESD were performed for early esophageal neoplasms. Among these 409 procedures, 32 (7.8%) patients developed esophageal strictures requiring endoscopic treatment: 7/161 after EMR (4.3%) and 25/248 (10.1%) after ESD. The mean age of patients was 66 ± 10 years . The indication for endoscopic resection was Barrett’s neoplasia in 15/32 cases (46.9%) and squamous cell neoplasia in 17/32 cases (53.1%). The median length of hospital stay after endoscopic resection was one day (± 0.9) and no severe adverse event was reported. The mean circumferential extent of the lesion was 63 ± 30%, while the resection wound was 90 ± 10% of the esophageal circumference. The median number of esophageal dilatation for post-resection stricture was 3 sessions (± 3). 19% (6/32) patients only requested 1 dilatation. Finally, the endoscopic dilatations allowed after a mean 23.1 ± 20 months follow-up (after the first dilatation)

a prolonged relief in dysphagia in 29/32 (90.6%) patients.

Conclusions Esophageal stricture after endoscopic resection for early neoplasia was an uncommon adverse event in our experience. After a median of 3 endoscopic dilatations, 90.6% of patients were permanently relieved of dysphagia. Effective preventive treatments for post-endoscopic esophageal stricture remain to be identified.