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Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms

BACKGROUND: Adverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation. AIM: To investigate the incidence and ri...

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Autores principales: Chen, Wei, Zhu, Xiao-Nan, Wang, Jin, Zhu, Lin-Lin, Gan, Tao, Yang, Jin-Lin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747285/
https://www.ncbi.nlm.nih.gov/pubmed/31558865
http://dx.doi.org/10.3748/wjg.v25.i34.5174
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author Chen, Wei
Zhu, Xiao-Nan
Wang, Jin
Zhu, Lin-Lin
Gan, Tao
Yang, Jin-Lin
author_facet Chen, Wei
Zhu, Xiao-Nan
Wang, Jin
Zhu, Lin-Lin
Gan, Tao
Yang, Jin-Lin
author_sort Chen, Wei
collection PubMed
description BACKGROUND: Adverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation. AIM: To investigate the incidence and risk factors of the MWT during esophageal ESD. METHODS: From June 2014 to July 2017, patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed. The clinicopathological characteristics of the patients were collected. Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD. The incidence of MWTs was determined, and the risk factors for MWT were then further explored. RESULTS: A total of 337 patients with 373 lesions treated by ESD were analyzed. Twenty patients developed MWTs during ESD (5.4%). Multivariate analysis identified that female sex (OR = 5.36, 95%CI: 1.47-19.50, P = 0.011) and procedure time longer than 88.5 min (OR = 3.953, 95%CI: 1.497-10.417, P = 0.005) were independent risk factors for an MWT during ESD. The cutoff value of the procedure time for an MWT was 88.5 min (sensitivity, 65.0%; specificity, 70.8%). Seven of the MWT patients received endoscopic hemostasis. All patients recovered satisfactorily without surgery for the laceration. CONCLUSION: The incidence of MWTs during esophageal ESD was much higher than expected. Although most cases have a benign course, fatal conditions may occur. We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.
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spelling pubmed-67472852019-09-26 Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms Chen, Wei Zhu, Xiao-Nan Wang, Jin Zhu, Lin-Lin Gan, Tao Yang, Jin-Lin World J Gastroenterol Retrospective Study BACKGROUND: Adverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation. AIM: To investigate the incidence and risk factors of the MWT during esophageal ESD. METHODS: From June 2014 to July 2017, patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed. The clinicopathological characteristics of the patients were collected. Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD. The incidence of MWTs was determined, and the risk factors for MWT were then further explored. RESULTS: A total of 337 patients with 373 lesions treated by ESD were analyzed. Twenty patients developed MWTs during ESD (5.4%). Multivariate analysis identified that female sex (OR = 5.36, 95%CI: 1.47-19.50, P = 0.011) and procedure time longer than 88.5 min (OR = 3.953, 95%CI: 1.497-10.417, P = 0.005) were independent risk factors for an MWT during ESD. The cutoff value of the procedure time for an MWT was 88.5 min (sensitivity, 65.0%; specificity, 70.8%). Seven of the MWT patients received endoscopic hemostasis. All patients recovered satisfactorily without surgery for the laceration. CONCLUSION: The incidence of MWTs during esophageal ESD was much higher than expected. Although most cases have a benign course, fatal conditions may occur. We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region. Baishideng Publishing Group Inc 2019-09-14 2019-09-14 /pmc/articles/PMC6747285/ /pubmed/31558865 http://dx.doi.org/10.3748/wjg.v25.i34.5174 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Chen, Wei
Zhu, Xiao-Nan
Wang, Jin
Zhu, Lin-Lin
Gan, Tao
Yang, Jin-Lin
Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms
title Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms
title_full Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms
title_fullStr Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms
title_full_unstemmed Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms
title_short Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms
title_sort risk factors for mallory-weiss tear during endoscopic submucosal dissection of superficial esophageal neoplasms
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747285/
https://www.ncbi.nlm.nih.gov/pubmed/31558865
http://dx.doi.org/10.3748/wjg.v25.i34.5174
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