Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5174
Peer-review started: April 8, 2019
First decision: May 24, 2019
Revised: June 15, 2019
Accepted: June 25, 2019
Article in press: June 26, 2019
Published online: September 14, 2019
Endoscopic submucosal dissection (ESD) has been widely accepted as an effective treatment for superficial esophageal neoplasms when the risk of lymph node metastasis is diagnosed as being very low or negligible. With the development of endoscopic technology and growing emphasis on the diagnosis and endoscopic treatment of early esophageal cancer, the ESD-associated Mallory-Weiss Tear (MWT) is reported case by case.
Adverse events during ESD of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, MWT during esophageal ESD remains under investigation. The present study was carried out to investigate the incidence and risk factors of MWT during esophageal ESD, since no literature has focused on the risk factors for an MWT during esophageal ESD.
The present study aimed to clarify the incidence of WMTs during esophageal ESD, and to evaluate the associated risk factors.
Patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed. The clinicopathological characteristics of the patients were collected. Patients were divided into a MWT group and non-MWT group based on whether MWT occurred during ESD. The incidence of MWTs was determined, and the risk factors for an MWT were then further explored.
Twenty patients developed MWTs during ESD (5.4%). Multivariate analysis identified that female sex (OR = 5.36, 95%CI: 1.47-19.50, P = 0.011) and procedure time longer than 88.5 min (OR = 3.953, 95%CI: 1.497-10.417, P = 0.005) were independent risk factors for an MWT during ESD. The cutoff value of the procedure time for an MWT was 88.5 min (sensitivity, 65.0%; specificity, 70.8%).
The incidence of MWTs during esophageal ESD was much higher than expected. Although most cases have a benign course, fatal conditions may occur. We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.
The present study aimed to clarify the incidence of WMTs during esophageal ESD, and to evaluate associated risk factors. In this work, we found that female sex and procedure time were independent risk factors for an MWT during ESD. For patients with such characteristics, clinicians must remain vigilant and perform careful observations after ESD.