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Timing of pyloric stenosis and effectiveness of endoscopic balloon dilation after pyloric endoscopic submucosal dissection. 2021

Hiroshi Takayama, and Takashi Toyonaga, and Tetsuya Yoshizaki, and Hirofumi Abe, and Tatsuya Nakai, and Chise Ueda, and Satoshi Urakami, and Hidetoshi Kaku, and Yusaku Shimamoto, and Kei Matsumoto, and Kazunori Tsuda, and Hiroya Sakaguchi, and Koki Matsuoka, and Shinichi Baba, and Hiroshi Takihara, and Nobuaki Ikezawa, and Shinwa Tanaka, and Madoka Takao, and Toshitatsu Takao, and Yoshinori Morita, and Yuzo Kodama
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

OBJECTIVE There have been studies on risk factors for stenosis after pyloric endoscopic submucosal dissection (ESD). However, the most appropriate strategies for the management of cases with these risk factors have not been established. This study aimed to investigate post-ESD management by evaluating the timing of stenosis and the effectiveness of endoscopic balloon dilation (EBD) after pyloric ESD. METHODS We retrospectively reviewed cases of pyloric ESD. We first reassessed risk factors for stenosis in multivariate analysis and receiver operating characteristic curve and defined patients with the identified risk factors as the risk group. The primary outcome was the timing of stenosis in the risk group assessed by the Kaplan-Meier method. RESULTS We reviewed 159 cases with pyloric ESD and observed pyloric stenosis in 25 cases. Cases with circumferential mucosal defect ≥ 76% were identified as the risk group. The stenosis-free probability in the risk group was 97% (95% confidence interval [CI]: 79-100%), 94% (95% CI: 76-98%), and 85% (95% CI: 66-93%) on days 7, 14, and 21, respectively. It decreased every week thereafter and did not significantly change after day 56. Twenty-three stenosis cases, except for conservative improvement, including six whole circumferential pyloric ESD cases, were improved by EBD without complications. CONCLUSIONS Post-ESD stenosis often developed from the third to the eighth week. In all pyloric ESD cases, including whole circumferential pyloric ESD cases, pyloric stenosis was improved following EBD without complications.

UI MeSH Term Description Entries
D011707 Pyloric Stenosis Narrowing of the pyloric canal with varied etiology. A common form is due to muscle hypertrophy (PYLORIC STENOSIS, HYPERTROPHIC) seen in infants. Pyloric Obstruction,Pylorus Obstruction,Stenosis, Pyloric,Obstruction, Pyloric,Obstruction, Pylorus,Pyloric Obstructions,Pylorus Obstructions
D011708 Pylorus The region of the STOMACH at the junction with the DUODENUM. It is marked by the thickening of circular muscle layers forming the pyloric sphincter to control the opening and closure of the lumen. Pyloric Sphincter,Pyloric Sphincters,Sphincter, Pyloric,Sphincters, Pyloric
D004106 Dilatation The act of dilating. Dilation,Dilatations,Dilations
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000069916 Endoscopic Mucosal Resection A method for removing lesions from gastrointestinal MUCOUS MEMBRANES. The mucosal tissue with the lesion is elevated by injecting a solution into the submucosal layer underneath it. The elevated tissue with the lesion is then cut out. Endoscopic Full Thickness Resection,Submucosal Tunneling Endoscopic Resection,Endoscopic Mucous Membrane Resection,Endoscopic Submucosal Dissection,Strip Biopsy,Biopsy, Strip,Dissection, Endoscopic Submucosal,Endoscopic Mucosal Resections,Endoscopic Submucosal Dissections,Mucosal Resection, Endoscopic,Resection, Endoscopic Mucosal,Strip Biopsies,Submucosal Dissection, Endoscopic
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D013997 Time Factors Elements of limited time intervals, contributing to particular results or situations. Time Series,Factor, Time,Time Factor
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes

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