title: Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer.
abstract: BACKGROUND
  Endoscopic dilation (ED) is used for the treatment of benign strictures caused by reflux esophagitis or anastomotic stenosis after esophagectomy. Esophageal stenosis is a major complication after endoscopic submucosal dissection (ESD) of large superficial esophageal cancer, but little is known regarding the incidence of complications of ED for stenosis caused by esophageal ESD.
  
  
  METHODS
  This was a retrospective study conducted at a single institution. From September 2002 to December 2012, a total of 1,337 ED procedures were performed for stenosis after esophageal ESD in 121 patients. The incidence of complications of ED and related clinical characteristics were analyzed.
  
  
  RESULTS
  The incidence of bleeding was 0.8 % (1/121) per patient and 0.07 % (1/1,337) per procedure. The incidence of perforation was 4.1 % (5/121) per patient and 0.37 % (5/1,337) per procedure. Perforation occurred at a median of third time of ED procedures (range 2-9 procedures) and at a median of 18 days (range 8-29 days) after ESD. There were no significant characteristics correlated to perforation, such as location, circumferential extent, or diameter of mucosal defect after ESD. The total number of ED procedures was significantly larger among perforation cases (37, range 6-57) compared with those without perforation (7, range 1-70) (p = 0.01), and the treatment duration tended to be longer (190 vs. 69 days, respectively).
  
  
  CONCLUSIONS
  The incidence of bleeding caused by ED for esophageal stenosis after ESD was very low. Relevant risk of perforation should be considered for patients requiring multiple ED procedures.
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan. y.kishida@scchr.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kishida
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan. kakushin-tky@umin.ac.jp.
authors.forename: Naomi
authors.initials: N
authors.lastname: Kakushima
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Kawata
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Takizawa
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Imai
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan.
authors.forename: Kinichi
authors.initials: K
authors.lastname: Hotta
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsubayashi
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004106:Dilatation / Q000009:adverse effects*; D004210:Dissection / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D012189:Retrospective Studies
keywords: Endoscopic dilation; Endoscopic submucosal dissection; Esophageal stenosis