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©The Author(s) 2019.
World J Gastroenterol. Sep 14, 2019; 25(34): 5174-5184
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5174
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5174
Table 1 Clinicopathological features of all patients and lesions
| Characteristics | n (%)/median (range) |
| No. of patients | 337 |
| Age in yr | 62 (37-83) |
| Sex | |
| Male | 228 (67.7) |
| Female | 109 (32.3) |
| Concomitant diseases | |
| Atrophic gastritis | 15 (4.4) |
| Hiatal hernia | 2 (0.6) |
| History of distal gastrectomy | 4 (1.2) |
| No. of lesions | 373 |
| Location | |
| Upper | 21 (5.6) |
| Middle | 252 (67.6) |
| Lower | 100 (26.8) |
| Longitudinal diameter of specimen in cm | 4.0 (1.0-14.0) |
| Circumferential diameter of specimen in cm | 2.5 (0.5-7.0) |
| Size of specimen in cm2 | 9.8 (0.5-70.0) |
| Circumferential extent of the mucosal defect | |
| < 75% | 268 (71.8) |
| ≥ 75% | 105 (28.2) |
| Histology and depth of invasion | |
| Intraepithelial neoplasia | 131 (35.1) |
| Mucosa | 195 (52.3) |
| Sub-mucosa < 200 μm | 21 (5.6) |
| Sub-mucosa ≥ 200 μm | 26 (7.0) |
| Procedure time in min | 60 (12-240) |
| En bloc resection | 359 (96.2) |
| Curative resection | 321 (86.1) |
| Type of ESD procedure | |
| Conventional ESD | 33 (8.8) |
| ESTD | 340 (91.2) |
| Endoscopists | |
| Experienced | 224 (60.1) |
| Less-experienced | 149 (39.9) |
| Adverse events | |
| MWT | 20 (5.4) |
| Perforation | 6 (1.6) |
| Stenosis | 46 (12.3) |
Table 2 Univariate analysis for risk factors of Mallory-Weiss Tear
| MWT | Non-MWT | P value | |
| No. of patients | 20 | 317 | |
| Age in yr, median (range) | 65 (47-77) | 62 (37-83) | 0.065 |
| Sex as male/female | 6/14 | 222/95 | a0.001 |
| Concomitant disease, n | |||
| Atrophic gastritis | 0 | 15 | 1.000 |
| Hiatal hernia | 0 | 2 | 1.000 |
| History of distal gastrectomy | 0 | 4 | 1.000 |
| No. of lesions | 20 | 353 | |
| Location of the center | 0.566 | ||
| Upper | 2 (10.0) | 19 (5.4) | |
| Middle | 13 (65.0) | 239 (67.7) | |
| Lower | 5 (25.0) | 95 (26.9) | |
| Longitudinal diameter in cm, median (range) | 5 (2-8) | 4 (1-14) | 0.125 |
| Circumferential diameter in cm, median (range) | 2.75 (1-5) | 2.5 (0.5-7) | 0.591 |
| Size of specimen in cm2, median (range) | 11.25 (2-32.5) | 9.6 (0.5-70) | 0.312 |
| Circumferential extent of the mucosal defect | 0.085 | ||
| < 75% | 11 (55) | 257 (72.8) | |
| ≥ 75% | 9 (45) | 96 (27.2) | |
| Depth of invasion | 0.377 | ||
| Intraepithelial neoplasia | 4 (20) | 127 (36.0) | |
| Mucosa | 13 (65) | 182 (51.6) | |
| Submucosa < 200 μm | 1 (5) | 20 (5.7) | |
| Submucosa ≥ 200 μm | 2 (10) | 24 (6.8) | |
| Submucosal adhesion, n | 3 (15) | 36 (10.2) | 0.452 |
| Procedure time in min, median (range) | 90 (28-180) | 58 (12-240) | a0.008 |
| Type of resection | 0.694 | ||
| Conventional ESD | 2 (10) | 31 (8.8) | |
| ESTD | 18 (90) | 322 (91.2) | |
| Operators | 0.635 | ||
| Experienced | 11(55) | 213 (60.3) | |
| Less-experienced | 9 (45) | 140 (39.7) | |
Table 3 Multivariate analysis for Mallory-Weiss Tear during esophageal endoscopic submucosal dissection
Table 4 Clinical characteristics of patients who developed Mallory-Weiss Tear during endoscopic submucosal dissection
| Patients | Age in yr | Sex | Location | Circumfe-rential of mucosal defect | Procedure time in min | Expert | Endoscopic treatment of MWT | Invasion depth | Submucosal adhesion |
| Case 1 | 72 | F | M | 3/5 | 60 | Y | - | Tis | N |
| Case 2 | 61 | M | L | 3/4 | 69 | Y | - | Tis | N |
| Case 3 | 63 | F | M | 1/2 | 28 | Y | - | Tis | N |
| Case 4 | 47 | M | L | 1/3 | 45 | Y | - | LGIN | N |
| Case 5 | 65 | F | M | 3/4 | 90 | N | - | HGIN | N |
| Case 6 | 64 | F | M | 4/5 | 98 | Y | - | M2 | Y |
| Case 7 | 51 | F | M | 4/5 | 121 | Y | E & APC1 | M2 | N |
| Case 8 | 66 | F | M | 2/3 | 125 | N | - | Tis | N |
| Case 9 | 64 | F | M | 4/5 | 175 | N | - | Tis | N |
| Case 10 | 77 | M | L | 1 | 180 | N | APC | SM, 550 μm | N |
| Case 11 | 60 | F | M | 1/4 | 45 | N | - | LGIN | N |
| Case 12 | 67 | F | M | 2/3 | 100 | N | APC | SM, 100 μm | N |
| Case 13 | 67 | M | L | 1/2 | 90 | N | - | M3 | N |
| Case 14 | 57 | M | M | 5/6 | 155 | N | APC | M2 | N |
| Case 15 | 69 | F | M | 1/2 | 57 | Y | Clips | HGIN | Y |
| Case 16 | 66 | F | M | 1/2 | 40 | Y | Clips | Tis | Y |
| Case 17 | 67 | M | L | 1 | 105 | Y | Clips and loop | M2 | N |
| Case 18 | 65 | F | M | 2/3 | 89 | Y | - | M2 | N |
| Case 19 | 64 | F | U | 1 | 150 | Y | - | M2 | N |
| Case 20 | 67 | F | U | 2/3 | 90 | N | - | SM, 220 μm | N |
- Citation: Chen W, Zhu XN, Wang J, Zhu LL, Gan T, Yang JL. Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms. World J Gastroenterol 2019; 25(34): 5174-5184
- URL: https://www.wjgnet.com/1007-9327/full/v25/i34/5174.htm
- DOI: https://dx.doi.org/10.3748/wjg.v25.i34.5174