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Endoscopic submucosal dissection for lesions involving the anastomosis after upper gastrointestinal surgery

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Abstract

Background and aims

Endoscopic submucosal dissection (ESD) for anastomotic lesions is technically challenging due to severe fibrosis, deformity, staples, and limited space for procedure. We aimed to characterize the clinicopathological characteristics, feasibility, and effectiveness of ESD for anastomotic lesions of the upper gastrointestinal tract.

Methods

We retrospectively investigated 43 patients with lesions involving the anastomoses of the upper GI tract who underwent ESD from April 2007 to February 2021. We collected clinicopathological characteristics, procedure‑related parameters and outcomes, and follow‑up data and analyzed the impact of anastomotic involvement.

Results

The median duration from previous upper GI surgery was 60 months and the median procedure duration was 30 min. The rate of en bloc resection and en bloc with R0 resection was 90.7% and 81.4%, respectively. Two patients (4.7%) experienced major adverse events, including delayed bleeding and febrile episode. During a median follow-up of 80 months, 3 patients had local recurrence and 4 patients had metastases. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 89.6% and 95.1%, respectively. Compared with the unilaterally involving group, the straddling anastomosis group had significantly longer procedure duration, larger specimen, lower rates of en bloc resection and en bloc with R0 resection, and shorter DFS and OS (all P < 0.05). However, rates of adverse events did not differ significantly between the two groups.

Conclusions

The short‑ and long-term outcomes of ESD for upper GI anastomotic lesions were favorable. Although with technically challenging, ESD could be performed safely and effectively for anastomotic lesions.

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Acknowledgements

This study was supported by grants from the National Key R&D Program of China (2019YFC1315800), National Natural Science Foundation of China (82000507), Yangfan Program of Shanghai Municipal Science and Technology Committee (S2020-016), and Youth Foundation of Zhongshan Hospital, Fudan University (2020ZSQN16). No other financial relationships relevant to this publication was disclosed.

Funding

This study was supported by grants from the National Key R&D Program of China (2019YFC1315800), National Natural Science Foundation of China (82000507), Yangfan Program of Shanghai Municipal Science and Technology Committee (S2020-016), and Youth Foundation of Zhongshan Hospital, Fudan University (2020ZSQN16).

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Author notes

  1. Li Wang, Zu-Qiang Liu, and Jing-Zheng Liu are co-first authors.

Authors and Affiliations

  1. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China

    Li Wang, Zu-Qiang Liu, Jing-Zheng Liu, Li-Yun Ma, Xiao-Qing Li, Lu Yao, Quan-Lin Li & Ping-Hong Zhou

  2. Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

    Quan-Lin Li & Ping-Hong Zhou

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  1. Li Wang
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Contributions

Z-QL, P-HZ, and Q-LLcontributed to planning and conducting the study. LW, Z-QL, L-YM, X-QL, LY, Q-LL, and P-HZ contributed to collecting the data. LW, Z-QL, J-ZL, L-YM, X-QL, LY, Q-LL, and P-HZ contributed to analyzing and interpreting the data. LW, Z-QL, J-ZL, L-YM, X-QL, LY, Q-LL, and P-HZ contributed to drafting the manuscript. LW, Z-QL, Q-LL, and P-HZ contributed to critical revision of manuscript. All authors contributed to final approval of the manuscript: .

Corresponding authors

Correspondence to Quan-Lin Li or Ping-Hong Zhou.

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Disclosures

Drs. Li Wang, Zu-Qiang Liu, Jing-Zheng Liu, Li-Yun Ma, Xiao-Qing Li, Lu Yao, Quan-Lin Li, and Ping-Hong Zhou have no conflict of interest or financial ties to disclose.

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Wang, L., Liu, ZQ., Liu, JZ. et al. Endoscopic submucosal dissection for lesions involving the anastomosis after upper gastrointestinal surgery. Surg Endosc 37, 2806–2816 (2023). https://doi.org/10.1007/s00464-022-09776-9

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  • DOI: https://doi.org/10.1007/s00464-022-09776-9

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