title: Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma.
abstract: OBJECTIVE
  Growing evidence suggests that esophageal stricture frequently develops after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) in early esophageal cancer patients, with an incidence proportional to the greater extent of mucosal defects resulting from improved EMR/ESD techniques. There seems to be a potential risk of perforation during bougienage in such patients.
  
  
  METHODS
  648 stricture dilations for 78 lesions in 76 patients were consecutively included. The outcomes after combined use of Maloney and Savary wire-guided bougienage for esophageal strictures after EMR/ESD were analyzed in a single-institute retrospective case series study. The perforation rate was determined and risk factors for perforation were identified.
  
  
  RESULTS
  Patients underwent a median of 5.0 dilation procedures performed over a median 3.0 months for post-EMR/ESD strictures. Initial dilation was done a median 14 days following endoscopic resection. Perforations developed in seven patients (7/648 dilation procedures, 1.1%), all in the lower esophagus, and bleeding occurred in one patient (0.1% dilations). Two independent risk factors for development of perforation during dilation therapy for post-EMR/ESD stricture were identified: multiple dilations (odds ratio [OR] 1.2; P=0.012), and lower site of stricture (OR 12.8; P=0.043). Dysphagia was ameliorated by the dilations, and no patient required surgery.
  
  
  CONCLUSIONS
  A specific emerging risk of perforation in dilation therapy for post-EMR/ESD strictures was identified. Carefully planned treatment is necessary in patients with severe post-EMR/ESD strictures especially strictures requiring multiple dilations or located in the lower esophagus.
authors.affiliation: Department of Gastroenterology, Keiyukai Sapporo Hospital, Sapporo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Takahashi
authors.forename: Y
authors.initials: Y
authors.lastname: Arimura
authors.forename: S
authors.initials: S
authors.lastname: Okahara
authors.forename: S
authors.initials: S
authors.lastname: Uchida
authors.forename: S
authors.initials: S
authors.lastname: Ishigaki
authors.forename: H
authors.initials: H
authors.lastname: Tsukagoshi
authors.forename: Y
authors.initials: Y
authors.lastname: Shinomura
authors.forename: M
authors.initials: M
authors.lastname: Hosokawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004106:Dilatation / Q000009:adverse effects* / Q000295:instrumentation; D004938:Esophageal Neoplasms / Q000601:surgery*; D004939:Esophageal Perforation / Q000453:epidemiology* / Q000209:etiology*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy / Q000009:adverse effects*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome