Effect of Esophageal Endoscopic Submucosal Dissection on Motility and Symptoms: A Prospective Study.

Tsutomu Takeda,Yuji Shimada,Kenshi Matsumoto,Yuta Nakagawa,Daisuke Asaoka,Yoichi Akazawa,Takashi Yao,Akihito Nagahara,Sumio Watanabe,Hiroya Ueyama,Kohei Matsumoto,Mariko Hojo,Kentaro Izumi,Hiroyuki Komori

doi:10.1155/2018/3735473

Abstract

Background Endoscopic submucosal dissection (ESD) of esophageal tumors can cause stenosis, yet the effect of esophageal ESD on motility remains unclarified. This study aimed to compare esophageal motility and symptoms, before and after ESD, using high-resolution manometry (HRM) and symptom scoring. Methods Twenty-eight patients with 35 cT1a cancers were prospectively enrolled between December 2014 and February 2016. Pre- and post-ESD symptom score and HRM were recorded. Based on circumferential resection (CR), patients were divided into group A (n = 17, <2/3 CR) or B (n = 11, 2/3 CR or greater). HRM parameters evaluated were distal contractile integral (DCI), contractile front velocity (CFV), intrabolus pressure, integrated relaxation pressure, distal latency, and peristaltic breaks. Results Symptom scores worsened after ESD in 8/11 patients in group B, and 0/17 patients in group A. There was no significant difference in any HRM parameter after ESD in the whole study group but mean DCI tended to increase (p = 0.07). In group B, DCI increased significantly after ESD (p = 0.04), and CFV tended to decrease after ESD (p = 0.08). Conclusions DCI tended to increase after esophageal ESD. ESD affected the symptom score and esophageal motility in cases with 2/3 CR or greater. This trial is registered with UMIN000015829.

Highlights

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of early esophageal cancers have been performed widely [1,2,3]
Fourteen other patients were excluded for various reasons: four underwent additional surgery after Endoscopic submucosal dissection (ESD), one had cerebrovascular disease, one had aspiration pneumonia, two underwent Argon-plasma coagulation, four due to the inability to insert the catheter, and two had other lesions and were resected on separate days (Figure 4)
In group A, there was no significant difference in distal contractile integral (DCI), contractile front velocity (CFV), Intrabolus pressure (IBP), Integrated relaxation pressure (IRP), Distal latency (DL), and Peristaltic breaks (PB) before ESD compared with their respective values after ESD (Table 3)

Summary

Introduction

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of early esophageal cancers have been performed widely [1,2,3]. High-resolution manometry (HRM) is a recent development that allows detailed evaluation of esophageal motility disorders. HRM has gained popularity mainly in Europe and the United States; it has been used to evaluate the presence or absence of esophageal motility disorders in many patients, and the Chicago classification was updated in 2012 and 2015 [10, 11]. This study aimed to compare esophageal motility and symptoms, before and after ESD, using highresolution manometry (HRM) and symptom scoring. There was no significant difference in any HRM parameter after ESD in the whole study group but mean DCI tended to increase (p = 0 07). ESD affected the symptom score and esophageal motility in cases with 2/3 CR or greater.

Objectives

Methods

Results

Conclusion