Ulcer Healing Process Following Endoscopic Resection of Esophageal Tumors and Analysis of Factors That Affect the Process

Abstract

Objective: Endoscopic submucosal dissection (ESD) is conducted in an increasing number of patients with esophageal tumors as its popularity increases and surgeons' techniques improve. However, the esophageal ulcer healing process following ESD has not been analyzed, and whether esophageal ulcers following ESD show a healing process similar to that seen following gastric ESD remains unknown. We conducted a retrospective study of the ulcer healing process following ESD and found that the healing of esophageal ulcers following ESD shows two different patterns. Factors that affect the healing process were analyzed. Subjects and methods: Included in the present study were 75 patients who underwent ESD for esophageal tumors between April 2005 and September 2006. Of the 82 lesions, 49 were analyzed after excluding 33 which could not be followed up due to additional resection or stenosis following ESD. Endoscopy was conducted 4-8 weeks after ESD to observe the ulcer healing status. Two different healing patterns were noted, so clinical factors (such as the diameter of resected specimens, duration of fasting after ESD, time needed for ESD, and past history) that affect the healing process were evaluated. Results: Forty-three men and six women, aged 64.5 on the average, were included in the study. Post-ESD ulcers became ulcer scars in 83% of cases 4 weeks after ESD and 100% of cases 6 weeks after ESD and onward. Two healing patters were noted: converging type, which shows tightening of the mucosa as if it was pulled toward the ulcer center, and elevation type, which shows the regenerative epithelium that built up from the ulcer bottom without showing mucosal tightening. The converging type was noted in 39 cases and the elevation type in 10. The maximum diameter of resected specimens was 34.6 mm and 48 mm, respectively, for the converging type and the elevation type; duration of fasting after ESD 1.8 and 3.3 days; and time needed for ESD 71 and 101 min. All differences were statistically significant (p = 0.02, p = 0.0078, p = 0.01). Conclusion: The ulcer healing process following ESD conducted for esophageal tumors showed two different patterns: converging type and elevation type. The diameter of resected specimens and duration of fasting after ESD appeared to affect the healing process. Stenosis is one of the major complications following esophageal ESD. However, our findings suggest that post-ESD stenosis can be prevented by inducing the elevation-type healing by fasting patients for 3 days or more following ESD even if the dissection diameter is large.