Timing of pyloric stenosis and effectiveness of endoscopic balloon dilation after pyloric endoscopic submucosal dissection
| Autor: | Tatsuya Nakai, Tetsuya Yoshizaki, Kei Matsumoto, Hiroshi Takihara, Chise Ueda, Hiroshi Takayama, Hiroya Sakaguchi, Takashi Toyonaga, Koki Matsuoka, Yusaku Shimamoto, Toshitatsu Takao, Kazunori Tsuda, Satoshi Urakami, Shinwa Tanaka, Madoka Takao, Hirofumi Abe, Shinichi Baba, Yuzo Kodama, Yoshinori Morita, Hidetoshi Kaku, Nobuaki Ikezawa |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Time Factors Endoscopic Mucosal Resection Perforation (oil well) Pyloric stenosis 03 medical and health sciences 0302 clinical medicine Risk groups medicine Humans Pyloric endoscopic submucosal dissention Pylorus Retrospective Studies Perforation Hepatology Receiver operating characteristic business.industry Gastroenterology Endoscopic submucosal dissection medicine.disease Dilatation Confidence interval Surgery Stenosis Treatment Outcome 030220 oncology & carcinogenesis Pyloric ESD Balloon dilation 030211 gastroenterology & hepatology EBD business Endoscopic balloon dilation |
| Zdroj: | Journal of Gastroenterology and Hepatology. 36:3158-3163 |
| ISSN: | 1440-1746 0815-9319 |
| DOI: | 10.1111/jgh.15582 |
| Popis: | Background and Aim There have been studies on risk factors for stenosis after pyloric endoscopic submucosal dissection (ESD). However, the most appropriate strategies for the management of cases with these risk factors have not been established. This study aimed to investigate post-ESD management by evaluating the timing of stenosis and the effectiveness of endoscopic balloon dilation (EBD) after pyloric ESD. Methods We retrospectively reviewed cases of pyloric ESD. We first reassessed risk factors for stenosis in multivariate analysis and receiver operating characteristic curve and defined patients with the identified risk factors as the risk group. The primary outcome was the timing of stenosis in the risk group assessed by the Kaplan–Meier method. Results We reviewed 159 cases with pyloric ESD and observed pyloric stenosis in 25 cases. Cases with circumferential mucosal defect ≥ 76% were identified as the risk group. The stenosis-free probability in the risk group was 97% (95% confidence interval [CI]: 79–100%), 94% (95% CI: 76–98%), and 85% (95% CI: 66–93%) on days 7, 14, and 21, respectively. It decreased every week thereafter and did not significantly change after day 56. Twenty-three stenosis cases, except for conservative improvement, including six whole circumferential pyloric ESD cases, were improved by EBD without complications. Conclusions Post-ESD stenosis often developed from the third to the eighth week. In all pyloric ESD cases, including whole circumferential pyloric ESD cases, pyloric stenosis was improved following EBD without complications. |
| Databáze: | OpenAIRE |
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