title: Management and risk factor of stenosis after endoscopic submucosal dissection for colorectal neoplasms.
abstract: OBJECTIVE
  Although endoscopic submucosal dissection (ESD) enables en bloc removal of large colorectal neoplasms, the incidence of stenosis after ESD and its risk factors have not been well described. This study aimed to determine the risk factors of stenosis and verify the surveillance and treatment of stenosis.
  
  
  METHODS
  This retrospective study included 822 patients, with a total of 912 consecutive colorectal lesions, who underwent ESD from September 2003 to May 2015. The main outcome measures were incidence of stenosis and its relationship with the clinicopathologic factors in surveillance.
  
  
  RESULTS
  Surveillance endoscopy was performed 6 months after ESD. Four of the 822 patients (0.49%) developed stenosis and required unanticipated endoscopy. The other 908 cases in 818 patients showed no symptoms or only slight abdominal discomfort (that was controlled with medication) and did not require any dilation or steroid therapies. Post-ESD stenosis was observed in 11.1% (2/18) of patients with circumferential resection between ≥90% and <100% and in 50% (2/4) of patients with circumferential resection of 100%. Among the 50 cases with a circumferential mucosal defect ≥75%, a circumferential mucosal defect ≥90% was a significant risk factor (P = .005). Four patients with stenosis were treated successfully by endoscopic dilation.
  
  
  CONCLUSIONS
  Circumferential mucosal defect of more than 90% is a significant risk factor for stenosis after colorectal ESD. Surveillance endoscopy 6 months after ESD is recommended to assess for development of stenosis. Defects smaller than 90% do not require close endoscopic follow-up or prophylactic measures for prevention of post-ESD stenosis. (UMIN clinical trial registration number: UMIN000015754.).
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Takemasa
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Shin-Ei
authors.initials: SE
authors.lastname: Kudo
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Miyachi
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ishigaki
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yagawa
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Toyoshima
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Misawa
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Toyoki
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Wakamura
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Atushi
authors.initials: A
authors.lastname: Katagiri
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Baba
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Ishida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D004106:Dilatation; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects*; D005260:Female; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019936:Probiotics / Q000627:therapeutic use; D012007:Rectum / Q000473:pathology*; D012307:Risk Factors
chemical_list: D054368:Laxatives