Autologous skin-grafting surgery to prevent esophageal stenosis after complete circular endoscopic submucosal tunnel dis
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and Other Interventional Techniques
Autologous skin‑grafting surgery to prevent esophageal stenosis after complete circular endoscopic submucosal tunnel dissection: a case‑matched controlled study Jiale Zou1 · Ningli Chai1 · Enqiang Linghu1 · Huikai Li1 · Mi Chai2 · Yongsheng Shi1 · Zantao Wang1 · Longsong Li1 Received: 18 June 2020 / Accepted: 1 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The incidence of postoperative stenosis after endoscopic resection of wholly circumferential superficial esophageal squamous cell neoplasms (SESCNs) is extremely high. Methods Between January 2011 and April 2019, 19 patients who underwent autologous skin-grafting surgery (ASGS) after complete circular endoscopic submucosal tunnel dissection (ccESTD) were enrolled to form the ASGS group. Cases in the ASGS group were individually matched at a 1:1 ratio to cases undergoing fully covered esophageal stent (FCES) placement alone (FCES group) based on pathological diagnosis, curative resection, longitudinal length of ulceration, lack of stent migration, time to stent removal, follow-up period and operators. Baseline characteristics and treatment outcomes were compared between the two groups. Results Baseline characteristics were comparable between the ASGS group and the FCES group. The incidence of patients with esophageal stenosis after removal of the stent in the ASGS group was significantly reduced compared that in the FCES group (36.8% vs 78.9%, p = 0.020). Comparison of preventive methods (ASGS vs FCES alone) between the stenosis group and nonstenosis group revealed that ASGS accounted for a higher proportion than FCES alone in the nonstenosis group (p = 0.020). Conclusions Compared with FCES placement alone, ASGS appeared to be more effective in preventing esophageal stenosis after ccESTD for SESCNs. Keywords Endoscopic submucosal tunnel dissection · Esophageal stenosis · Autologous skin-grafting surgery Esophageal stenosis is a severe adverse event of esophageal endoscopic submucosal dissection (ESD). Previous studies have shown that cervical location, circumferential Jiale Zou and Ningli Chai are co-first authors. Jiale Zou and Ningli Chai contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08081-7) contains supplementary material, which is available to authorized users. * Enqiang Linghu [email protected] 1
Department of Gastroenterology and Hepatology, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China
Department of Plastic Surgery, The First Medical Center of PLA General Hospital, Beijing 100853, China
2
extension > 3/4, and a longitudinal tumor diameter greater than 40 mm are risk factors for post-ESD stenosis [1–3]. The incidence of postoperative stenosis after resection of wholly circumferential esophageal lesions is extremely high, ranging from 88 to 100% [1]. Therefore, prophylactic options for
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