Analysis of factors associated with the occurrence of dysphagia after endoscopic submucosal dissection in patients with early esophageal cancer or precancerous lesions
10.3760/cma.j.cn311367-20231213-00212
- VernacularTitle:食管早期肿瘤及癌前病变患者内镜黏膜下剥离术后并发吞咽困难的相关因素分析
- Author:
Meihui LYU
1
;
Meifeng WANG
1
;
Guoxin ZHANG
1
;
Lin LIN
1
;
Liuqin JIANG
1
Author Information
1. 南京医科大学第一附属医院消化内科，南京 210029
- Publication Type:Journal Article
- Keywords:
Dysphagia;
Precancerous esophagus;
High resolution esophageal manometry;
Psychosomatic factors;
Circumferential resection scope
- From:
Chinese Journal of Digestion
2024;44(11):751-756
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the factors associated with the occurrence of dysphagia after endoscopic submucosal dissection(ESD) treatment in patients with early esophageal cancer or precancerous lesions, and to explore their clinical predictive value.Methods:From March 1, 2020 to March 31, 2021, 35 patients diagnosed with early esophageal cancer or precancerous lesions without dysphagia before ESD treatment were recruited. All the patients were followed up for 2 years after ESD, and were divided into the non-dysphagia group (22 cases) and dysphagia group (13 cases) according to the occurrence of postoperative dysphagia. The demographic characteristics(such as gender and age), ESD-related data (such as the range of circumferential resection), the parameters of high resolution esophageal manometry such as distal contraction integral(DCI), the amplitude of peristaltic waves in various esophageal segments, and the psychological states such as self-rating anxiety scale (SAS) scores of the 2 groups were analyzed. Multivariate logistic regression was used to analyze the independent influencing factors for the occurrence of dysphagia after ESD and receiver operating characteristic curve (ROC) of the independent risk factors was plotted to assess the diagnostic efficacy.Results:The result of multivariate logistic regression analysis showed that the range of circumferential resection ( OR=23.881, 95% confidence interval (95% CI) 4.073 to 140.022), the SAS score ( OR=1.157, 95% CI 1.029 to 1.300), the mean value of DCI ( OR=0.864, 95% CI 0.750 to 0.995) and the maximum value of DCI ( OR=0.914, 95% CI 0.837 to 0.998) were independent influencing factors for postoperative dysphagia (all P<0.05).The result of ROC analysis showed that the area under the curve for the range of circumferential resection predicting dysphagia after ESD was 0.895 (95% CI 0.788 to 0.987, P<0.001), with an optimal cut-off value of 72.50, and the area under the curve for SAS score was 0.811 (95% CI 0.660 to 0.962, P=0.001), with an optimal cut-off value of 34.38. Conclusions:Reduced distal esophageal pressure, and(or) contractile weakness may contribute to dysphagia after ESD. Postoperative dysphagia risk increases when the range of circumferential esophageal resection exceeds 72.5% of the lumen circumference or the SAS score is over 34.
