Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms

doi:10.3748/wjg.v25.i34.5174

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 25, Issue 34

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (7710)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-1) series, Tables (1-4) series.

Item

Count

PDF

419

WORD

182

HTML

4480

Figures (1-1)

295

Tables (1-4)

139

Sum=5515

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

662

Download

1533

Sum=2195

Sep 14, 2019 (publication date) through Apr 24, 2024

Times Cited of This Article

Times Cited (4)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Sep 14, 2019; 25(34): 5174-5184
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5174

Table 1 Clinicopathological features of all patients and lesions

Characteristics	n (%)/median (range)
No. of patients	337
Age in yr	62 (37-83)
Sex
Male	228 (67.7)
Female	109 (32.3)
Concomitant diseases
Atrophic gastritis	15 (4.4)
Hiatal hernia	2 (0.6)
History of distal gastrectomy	4 (1.2)
No. of lesions	373
Location
Upper	21 (5.6)
Middle	252 (67.6)
Lower	100 (26.8)
Longitudinal diameter of specimen in cm	4.0 (1.0-14.0)
Circumferential diameter of specimen in cm	2.5 (0.5-7.0)
Size of specimen in cm²	9.8 (0.5-70.0)
Circumferential extent of the mucosal defect
< 75%	268 (71.8)
≥ 75%	105 (28.2)
Histology and depth of invasion
Intraepithelial neoplasia	131 (35.1)
Mucosa	195 (52.3)
Sub-mucosa < 200 μm	21 (5.6)
Sub-mucosa ≥ 200 μm	26 (7.0)
Procedure time in min	60 (12-240)
En bloc resection	359 (96.2)
Curative resection	321 (86.1)
Type of ESD procedure
Conventional ESD	33 (8.8)
ESTD	340 (91.2)
Endoscopists
Experienced	224 (60.1)
Less-experienced	149 (39.9)
Adverse events
MWT	20 (5.4)
Perforation	6 (1.6)
Stenosis	46 (12.3)

ESD: Endoscopic submucosal dissection; MWT: Mallory-Weiss Tear; ESTD: Endoscopic submucosal tunnel dissection.

Table 2 Univariate analysis for risk factors of Mallory-Weiss Tear

	MWT	Non-MWT	P value
No. of patients	20	317
Age in yr, median (range)	65 (47-77)	62 (37-83)	0.065
Sex as male/female	6/14	222/95	^a0.001
Concomitant disease, n
Atrophic gastritis	0	15	1.000
Hiatal hernia	0	2	1.000
History of distal gastrectomy	0	4	1.000
No. of lesions	20	353
Location of the center			0.566
Upper	2 (10.0)	19 (5.4)
Middle	13 (65.0)	239 (67.7)
Lower	5 (25.0)	95 (26.9)
Longitudinal diameter in cm, median (range)	5 (2-8)	4 (1-14)	0.125
Circumferential diameter in cm, median (range)	2.75 (1-5)	2.5 (0.5-7)	0.591
Size of specimen in cm², median (range)	11.25 (2-32.5)	9.6 (0.5-70)	0.312
Circumferential extent of the mucosal defect			0.085
< 75%	11 (55)	257 (72.8)
≥ 75%	9 (45)	96 (27.2)
Depth of invasion			0.377
Intraepithelial neoplasia	4 (20)	127 (36.0)
Mucosa	13 (65)	182 (51.6)
Submucosa < 200 μm	1 (5)	20 (5.7)

Submucosa ≥ 200 μm	2 (10)	24 (6.8)
Submucosal adhesion, n	3 (15)	36 (10.2)	0.452
Procedure time in min, median (range)	90 (28-180)	58 (12-240)	^a0.008
Type of resection			0.694
Conventional ESD	2 (10)	31 (8.8)
ESTD	18 (90)	322 (91.2)
Operators			0.635
Experienced	11(55)	213 (60.3)
Less-experienced	9 (45)	140 (39.7)

^aP < 0.05. ESD: Endoscopic submucosal dissection; MWT: Mallory-Weiss Tear; ESTD: Endoscopic submucosal tunnel dissection.

Table 3 Multivariate analysis for Mallory-Weiss Tear during esophageal endoscopic submucosal dissection

Variable	OR	95%CI	P value
Age	1.037	0.977-1.101	0.229
Sex, female	5.270	1.940-14.320	^a0.001
Procedure time, > 88.5 min	3.953	1.497-10.417	^a0.005

^aP < 0.05.

Table 4 Clinical characteristics of patients who developed Mallory-Weiss Tear during endoscopic submucosal dissection

Patients	Age in yr	Sex	Location	Circumfe-rential of mucosal defect	Procedure time in min	Expert	Endoscopic treatment of MWT	Invasion depth	Submucosal adhesion
Case 1	72	F	M	3/5	60	Y	-	Tis	N
Case 2	61	M	L	3/4	69	Y	-	Tis	N
Case 3	63	F	M	1/2	28	Y	-	Tis	N
Case 4	47	M	L	1/3	45	Y	-	LGIN	N
Case 5	65	F	M	3/4	90	N	-	HGIN	N
Case 6	64	F	M	4/5	98	Y	-	M2	Y
Case 7	51	F	M	4/5	121	Y	E & APC¹	M2	N
Case 8	66	F	M	2/3	125	N	-	Tis	N
Case 9	64	F	M	4/5	175	N	-	Tis	N
Case 10	77	M	L	1	180	N	APC	SM, 550 μm	N
Case 11	60	F	M	1/4	45	N	-	LGIN	N
Case 12	67	F	M	2/3	100	N	APC	SM, 100 μm	N
Case 13	67	M	L	1/2	90	N	-	M3	N
Case 14	57	M	M	5/6	155	N	APC	M2	N
Case 15	69	F	M	1/2	57	Y	Clips	HGIN	Y
Case 16	66	F	M	1/2	40	Y	Clips	Tis	Y
Case 17	67	M	L	1	105	Y	Clips and loop	M2	N
Case 18	65	F	M	2/3	89	Y	-	M2	N
Case 19	64	F	U	1	150	Y	-	M2	N
Case 20	67	F	U	2/3	90	N	-	SM, 220 μm	N

¹Sprinkle of epinephrine solution (1:10000) and argon plasma coagulation treatment in the emergency endoscopy 10 h after endoscopic submucosal dissection. MWT: Mallory-Weiss Tear; Tis: Tumor in situ; LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia; APC: Argon plasma coagulation; M2: Lesion limited to laminae mucosa; SM: Lesion infiltration submucosa; F: Female; M: Male; U: Upper esophagus; M: Middle esophagus; L: Lower esophagus.

Citation: Chen W, Zhu XN, Wang J, Zhu LL, Gan T, Yang JL. Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms. World J Gastroenterol 2019; 25(34): 5174-5184
URL: https://www.wjgnet.com/1007-9327/full/v25/i34/5174.htm
DOI: https://dx.doi.org/10.3748/wjg.v25.i34.5174