Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2019; 25(34): 5174-5184
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5174
Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms
Wei Chen, Xiao-Nan Zhu, Jin Wang, Lin-Lin Zhu, Tao Gan, Jin-Lin Yang
Wei Chen, Xiao-Nan Zhu, Jin Wang, Lin-Lin Zhu, Tao Gan, Jin-Lin Yang, Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: All authors helped to perform the research; Chen W and Zhu XN contributed equally to this work. Chen W performed the manuscript writing and data analysis; Zhu XN performed the manuscript writing, drafting conception, and data analysis; Wang J, Zhu LL contributed to writing of the manuscript and design of the study; Gan T and Yang JL contributed to writing of the manuscript and drafting conception, performed the procedures, and designed the study.
Institutional review board statement: This research was reviewed and approved by the Ethics Committee of the West China Hospital of Sichuan University.
Informed consent statement: Written informed consent was obtained from all patients before treatment.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jin-Lin Yang, MD, MHSc, PhD, Chief Doctor, Doctor, Lecturer, MHSc, Professor, Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Guoxue Road No.37, Chengdu 610041, Sichuan Province, China. mouse-577@163.com
Telephone: +86-28-85423326 Fax: +86-28-85423326
Received: April 6, 2019
Peer-review started: April 8, 2019
First decision: May 24, 2019
Revised: June 15, 2019
Accepted: June 25, 2019
Article in press: June 26, 2019
Published online: September 14, 2019
Processing time: 159 Days and 17.3 Hours
Abstract
BACKGROUND

Adverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation.

AIM

To investigate the incidence and risk factors of the MWT during esophageal ESD.

METHODS

From June 2014 to July 2017, patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed. The clinicopathological characteristics of the patients were collected. Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD. The incidence of MWTs was determined, and the risk factors for MWT were then further explored.

RESULTS

A total of 337 patients with 373 lesions treated by ESD were analyzed. Twenty patients developed MWTs during ESD (5.4%). Multivariate analysis identified that female sex (OR = 5.36, 95%CI: 1.47-19.50, P = 0.011) and procedure time longer than 88.5 min (OR = 3.953, 95%CI: 1.497-10.417, P = 0.005) were independent risk factors for an MWT during ESD. The cutoff value of the procedure time for an MWT was 88.5 min (sensitivity, 65.0%; specificity, 70.8%). Seven of the MWT patients received endoscopic hemostasis. All patients recovered satisfactorily without surgery for the laceration.

CONCLUSION

The incidence of MWTs during esophageal ESD was much higher than expected. Although most cases have a benign course, fatal conditions may occur. We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.

Keywords: Superficial esophageal neoplasms; Endoscopic submucosal dissection; Mallory-Weiss Tear; Incidence; Risk factors

Core tip: To our knowledge, no literature has focused on the risk factors for an Mallory-Weiss Tear (MWT) during esophageal endoscopic submucosal dissection (ESD). Thus, the present study aimed to clarify the incidence of WMTs during esophageal ESD, and to evaluate associated risk factors. In this work, we found that female sex and procedure time were independent risk factors for an MWT during ESD. For patients with such characteristics, clinicians must remain vigilant and perform careful observations after ESD.