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Timing of pyloric stenosis and effectiveness of endoscopic balloon dilation after pyloric endoscopic submucosal dissection
Author(s) -
Takayama Hiroshi,
Toyonaga Takashi,
Yoshizaki Tetsuya,
Abe Hirofumi,
Nakai Tatsuya,
Ueda Chise,
Urakami Satoshi,
Kaku Hidetoshi,
Shimamoto Yusaku,
Matsumoto Kei,
Tsuda Kazunori,
Sakaguchi Hiroya,
Matsuoka Koki,
Baba Shinichi,
Takihara Hiroshi,
Ikezawa Nobuaki,
Tanaka Shinwa,
Takao Madoka,
Takao Toshitatsu,
Morita Yoshinori,
Kodama Yuzo
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15582
Subject(s) - medicine , balloon dilation , pyloric stenosis , stenosis , pylorus , endoscopic submucosal dissection , constriction , confidence interval , surgery , balloon , stomach
Background and Aim 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.