Influence of endoscopic submucosal dissection on esophageal motility.
OBJECTIVE
To assess esophageal motility after esophageal endoscopic submucosal dissection (ESD).


METHODS
Twelve patients (6 men and 6 women) aged 53-64 years (mean age, 58 years) who underwent regular examination 3-12 mo after esophageal ESD for neoplasms of the esophageal body were included in this study. The ESD procedure was performed under deep sedation using a combination of propofol and fentanyl, and involved a submucosal injection to lift the lesion and use of a dual-knife and an insulated-tip knife to create a circumferential incision around the lesion extending into the submucosa. Esophageal motility was examined using a high-resolution manometry system. Dysphagia was graded using a five-point scale according to the Mellow and Pinkas scoring system. Patient symptoms and the results of esophageal manometry were then analyzed.


RESULTS
Of the 12 patients enrolled, 1 patient had grade 2 dysphagia, 1 patient had grade 1 dysphagia, and 3 patients complained of sporadic dysphagia. Ineffective esophageal motility was observed in 5 of 6 patients with above semi-circumference of resection extension. Of these 5 patients, 1 patient complained of grade 2 dysphagia (with esophageal stricture), one patient complained of grade 1 dysphagia, and 3 patients complained of sporadic dysphagia. Normal esophageal body manometry was observed in all 6 patients with below semi-circumference of resection extension. The 6 patients with normal esophageal motility did not complain of dysphagia.


CONCLUSIONS
Extensive esophageal ESD may cause esophageal dysmotility in some patients, and might also have an influence on dysphagia although without esophageal stricture.
Department of Gastroenterology and Hepatology, PLA General Hospital, Beijing 100853, China.
Bao-Guo
BG
Bu
En-Qiang
EQ
Linghu
Hui-Kai
HK
Li
Xiao-Xiao
XX
Wang
Rong-Bin
RB
Guo
Li-Hua
LH
Peng
D004210:Dissection / Q000009:adverse effects*; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D004945:Esophagoscopy / Q000009:adverse effects*; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
Dysphagia; Endoscopic submucosal dissection; Esophageal manometry; Esophageal neoplasm; Ineffective esophageal motility