title: Risk factors and management for gastric stenosis after endoscopic submucosal dissection for gastric epithelial neoplasm.
abstract: BACKGROUND
  Only a few studies have reported treatment options for stenosis after endoscopic submucosal dissection (ESD) for gastric neoplasms. This study aimed to identify the risk factors for and evaluate the management of stenosis after ESD for gastric epithelial neoplasms in the cardia and antrum.
  
  
  METHODS
  We retrospectively reviewed 1218 patients (1447 gastric epithelial neoplasms) who underwent ESD at Tonan Hospital from June 2004 to November 2015. Post-ESD stenosis was defined when a standard endoscope could not be passed through the site.
  
  
  RESULTS
  Post-ESD stenosis occurred in 10 (21.3%) of the 47 cardia cases and 14 (3.2%) of the 432 antrum cases. A wide resection of more than three fourths of the circumferential extent was the sole significant risk factor related to post-ESD stenosis in both cardia and antrum. Prophylactic endoscopic balloon dilation (EBD) was performed in 3 of 10 patients with cardiac stenosis and 4 of 14 with antral stenosis. Post-EBD bleeding occurred in one cardia (10%) and one antrum (7.1%) case each and was endoscopically treated. Perforation during EBD occurred in two (14.3%) antrum cases, both of which required emergency open surgery. All complications were observed in patients with conventional EBD, and no complications were associated with prophylactic EBD.
  
  
  CONCLUSIONS
  A wide resection of more than three fourths of the circumferential extent was the significant risk factor for post-ESD stenosis in both cardia and antrum, and prophylactic EBD could be a promising procedure for the management of post-ESD stenosis.
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan. t-sumiyoshi@tonan.gr.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kondo
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Minagawa
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Fujii
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Kaho
authors.initials: K
authors.lastname: Sakata
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ihara
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Naohito
authors.initials: N
authors.lastname: Yoshizaki
authors.affiliation: Department of Gastroenterology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Hirayama
authors.affiliation: Department of Pathology, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Oyamada
authors.affiliation: Department of Surgery, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Okushiba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013272:Stomach Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Early gastric cancer; Endoscopic balloon dilation (EBD); Endoscopic submucosal dissection (ESD); Gastric stenosis; Prophylactic endoscopic balloon dilation