Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application

Table 1 Demographics and characteristics of patients included in the study

Variables	Oral group (n = 53)	Combined group (n = 67)	F/χ2	P value
Age (years, mean ± SD)	67.70 ± 1.06	66.49 ± 0.94	0.73	0.40
BMI (kg/m2, mean ± SD)	22.87 ± 0.43	22.77 ± 0.38	0.03	0.86
Gender (male, %)	33 (62.3)	51 (76.1)	2.71	0.10
Smoke (%)	13 (24.5)	15 (22.4)	0.08	0.78
Macroscopic type [n (%)]			2.08	0.35
0-IIa	11 (20.7)	9 (13.4)
0-IIb	32 (60.4)	39 (58.2)
0-IIc	10 (18.9)	19 (28.4)
Histopathologic diagnosis [n (%)]			2.08	0.35
High-grade intraepithelial neoplasia	25 (47.2)	26 (38.8)
Esophageal squamous cell carcinoma	28 (52.8)	41 (61.2)
Lesion circumference [n (%)]			2.66	0.10
< 5/6 and ≥ 3/4	37 (69.8)	37 (55.2)
≥ 5/6	16 (30.2)	30 (44.8)
Length of lesion (mm, mean ± SD)	61.36 ± 2.91	60.55 ± 2.59	0.04	0.84
Depth of invasion [n (%)]			1.04	0.60
M1/M2	40 (75.5)	49 (73.1)
M3/SM1	8 (15.1)	14 (20.9)
SM2	5 (9.4)	4 (6.0)
Additional chemoradiotherapy [n (%)]	7 (13.2)	10 (14.9)	0.22	0.90
Tumor location [n (%)]			0.07	0.78
Cervical and upper thoracic esophagus	13 (24.5)	13 (19.4)
Middle thoracic esophagus	24 (45.3)	36 (53.7)
Lower thoracic esophagus	16 (30.2)	18 (26.9)

M1: Intraepithelial; M2: Lamina propria; M3: Muscularis mucosae; SM1: < 200 µm from the muscularis mucosae; SM2: ≥ 200 µm from the muscularis mucosae.

Table 2 Univariate and multivariate logistic regression analyses of predictors of post-esophageal endoscopic submucosal dissection stricture formation

Characteristics	Univariate analysis			Multivariate analysis
	Non-stricture (n = 20)	Stricture (n = 100)	P value	OR (95%CI)	P value
Age (year)	66.70 ± 10.41	67.09 ± 7.09	0.84	-	-
Gender [n (%)]			0.12
Male	11 (55.0)	129 (70.5)
Female	9 (45.0)	54 (29.5)
BMI	22.81 ± 3.72	22.82 ± 2.97	0.99	-	-
Smoke [n (%)]			0.31
Yes	3 (15.0)	25 (25.0)		-	-
No	17 (85.0)	75 (75.0)		-	-
Histopathologic diagnosis [n (%)]			0.21
High-grade intraepithelial neoplasia	6 (30.0)	45 (45.0)		-	-
Esophageal squamous cell carcinoma	14 (70.0)	55 (55.0)		-	-
Additional chemoradiotherapy [n (%)]			0.54
Yes	2 (10.0)	15 (15.0)		2.12 (0.41-11.10)	0.37
No	18 (90.0)	85 (85.0)		Reference	-
Tumor location [n (%)]			0.51
Cervical and upper thoracic esophagus	6 (30.0)	20 (20.0)		Reference
Middle thoracic esophagus	10 (50.0)	50 (50.0)		1.77 (0.49-6.41)	0.38
Lower thoracic esophagus	4 (20.0)	30 (30.0)		3.06 (0.64-14.53)	0.16
Macroscopic type [n (%)]			0.89
0-IIa	4 (20.0)	16 (16.0)		-	-
0-IIb	11 (55.0)	60 (60.0)		-	-
0-IIc	5 (25.0)	24 (24.0)		-	-
Clinical depth of invasion [n (%)]			0.79
Epithelium/lamina propria	16 (80.0)	73 (73.0)		-	-
MM/SM1	3 (15.0)	19 (19.0)		-	-
SM2	1 (5.0)	8 (8.0)		-	-
Procedure time (minute)	105.00 ± 62.56	81.53 ± 5.46	0.08	-	-
Endo-knife [n (%)]			0.17
Hook knife	2 (10.0)	7 (7.0)		-	-
IT/Dual knife	18 (90.0)	84 (84.0)		-	-
Hybrid knife	0 (0.0)	9 (9.0)		-	-
Electrosurgical unit modes [n (%)]			0.64
Swift coagulation	2 (10.0)	10 (10.0)		-	-
Forced coagulation	15 (75.0)	82 (82.0)		-	-
Endocut	3 (15.0)	8 (8.0)		-	-
Submucosal injection solution [n (%)]			0.04
Sodium hyaluronate	4 (20.0)	5 (5.0)		0.15 (0.03-0.82)	0.03
Other	16 (80.0)	95 (95.0)		Reference
Steroids group [n (%)]			0.93
Oral steroids	9 (45.0)	44 (44.0)		Reference
Combined group	11 (55.0)	56 (56.0)		0.60 (0.20-1.82)	0.37
Longitudinal length of the resected lesion (mm)	63.60 ± 21.77	60.37 ± 21.03	0.53	-	-
Circumferential range [n (%)]			0.01
< 5/6 and ≥ 3/4	17 (85.0)	57 (57.0)		0.19 (0.05-0.74)	0.02
≥ 5/6	3 (15.0)	43 (43.0)		Reference
En bloc resection [n (%)]			0.91
Yes	17 (85.0)	84 (84.0)		-	-
No	3 (15.0)	16 (16.0)		-	-
Fibrin glue [n (%)]			0.12
Yes	9 (45.0)	64 (64.0)		-	-
No	11 (55.0)	36 (36.0)		-	-

95%CI: 95% confidence interval; OR: Odds ratio; BMI: Body mass index.