title: Risk of stricture after endoscopic submucosal dissection for large rectal neoplasms.
abstract: OBJECTIVE
  Improvements in the endoscopic submucosal dissection (ESD) technique have made circumferential ESD in the rectum possible. However, little is known about the clinical course after extensive ESD in the rectum. The aim of this study was to determine the stricture risk in the rectum after total or subtotal circumferential ESD.
  
  
  METHODS
  A total of 69 patients with 69 rectal tumors that required ≥ 75 % circumferential resection were identified at Kobe University Hospital and an affiliated hospital between April 2005 and May 2014. Among the patients, 61 were available for evaluation of stricture development, either by follow-up colonoscopy or by surgical specimens. The rate and possible risk factors of post-ESD strictures were investigated.
  
  
  RESULTS
  Post-ESD rectal strictures developed in 12 patients (19.7 %). Patients who underwent total circumferential ESD developed a stricture (5/7, 71.4 %) more frequently than those with subtotal (≥ 90 %) ESD (7/16, 43.8 %). Patients undergoing an ESD procedure that involved < 90 % of the circumference did not develop strictures. The strictures were membranous or < 10 mm long in all cases. Of the patients with stricture, 11 received endoscopic balloon dilation and one received bougie with short-caliber-tip transparent hood; all strictures improved following dilation therapy. Statistical analysis revealed that ≥ 90 % circumferential resection was an independent risk factor for stricture, whereas morphology and size were not.
  
  
  CONCLUSIONS
  Patients who underwent total or subtotal circumferential ESD of a rectal tumor had a high risk of stricture formation. Dilation helped to alleviate the stenosis.Study registered at University Hospital Medical Information Network (UMIN 000016559).
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Ohara
authors.affiliation: Department of Endoscopy, Kobe University Hospital, Kobe, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyonaga
authors.affiliation: Department of Endoscopy, Kobe University Hospital, Kobe, Japan.
authors.forename: Shinwa
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Namiko
authors.initials: N
authors.lastname: Hoshi
authors.affiliation: Department of Endoscopy, Kobe University Hospital, Kobe, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yoshizaki
authors.affiliation: Department of Endoscopy, Kobe University Hospital, Kobe, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kawara
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China.
authors.forename: Ka Luen
authors.initials: KL
authors.lastname: Lui
authors.affiliation: Unit of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Kanokkan
authors.initials: K
authors.lastname: Tepmalai
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Alisara
authors.initials: A
authors.lastname: Damrongmanee
authors.affiliation: Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Umegaki
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000236:Adenoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome