Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms

doi:10.3748/wjg.v25.i34.5174

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Sep 14, 2019 (publication date) through Feb 2, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Sep 14, 2019; 25(34): 5174-5184
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5174

Table 1 Clinicopathological features of all patients and lesions

Characteristics	n (%)/median (range)
No. of patients	337
Age in yr	62 (37-83)
Sex
Male	228 (67.7)
Female	109 (32.3)
Concomitant diseases
Atrophic gastritis	15 (4.4)
Hiatal hernia	2 (0.6)
History of distal gastrectomy	4 (1.2)
No. of lesions	373
Location
Upper	21 (5.6)
Middle	252 (67.6)
Lower	100 (26.8)
Longitudinal diameter of specimen in cm	4.0 (1.0-14.0)
Circumferential diameter of specimen in cm	2.5 (0.5-7.0)
Size of specimen in cm²	9.8 (0.5-70.0)
Circumferential extent of the mucosal defect
< 75%	268 (71.8)
≥ 75%	105 (28.2)
Histology and depth of invasion
Intraepithelial neoplasia	131 (35.1)
Mucosa	195 (52.3)
Sub-mucosa < 200 μm	21 (5.6)
Sub-mucosa ≥ 200 μm	26 (7.0)
Procedure time in min	60 (12-240)
En bloc resection	359 (96.2)
Curative resection	321 (86.1)
Type of ESD procedure
Conventional ESD	33 (8.8)
ESTD	340 (91.2)
Endoscopists
Experienced	224 (60.1)
Less-experienced	149 (39.9)
Adverse events
MWT	20 (5.4)
Perforation	6 (1.6)
Stenosis	46 (12.3)

ESD: Endoscopic submucosal dissection; MWT: Mallory-Weiss Tear; ESTD: Endoscopic submucosal tunnel dissection.

Table 2 Univariate analysis for risk factors of Mallory-Weiss Tear

	MWT	Non-MWT	P value
No. of patients	20	317
Age in yr, median (range)	65 (47-77)	62 (37-83)	0.065
Sex as male/female	6/14	222/95	^a0.001
Concomitant disease, n
Atrophic gastritis	0	15	1.000
Hiatal hernia	0	2	1.000
History of distal gastrectomy	0	4	1.000
No. of lesions	20	353
Location of the center			0.566
Upper	2 (10.0)	19 (5.4)
Middle	13 (65.0)	239 (67.7)
Lower	5 (25.0)	95 (26.9)
Longitudinal diameter in cm, median (range)	5 (2-8)	4 (1-14)	0.125
Circumferential diameter in cm, median (range)	2.75 (1-5)	2.5 (0.5-7)	0.591
Size of specimen in cm², median (range)	11.25 (2-32.5)	9.6 (0.5-70)	0.312
Circumferential extent of the mucosal defect			0.085
< 75%	11 (55)	257 (72.8)
≥ 75%	9 (45)	96 (27.2)
Depth of invasion			0.377
Intraepithelial neoplasia	4 (20)	127 (36.0)
Mucosa	13 (65)	182 (51.6)
Submucosa < 200 μm	1 (5)	20 (5.7)

Submucosa ≥ 200 μm	2 (10)	24 (6.8)
Submucosal adhesion, n	3 (15)	36 (10.2)	0.452
Procedure time in min, median (range)	90 (28-180)	58 (12-240)	^a0.008
Type of resection			0.694
Conventional ESD	2 (10)	31 (8.8)
ESTD	18 (90)	322 (91.2)
Operators			0.635
Experienced	11(55)	213 (60.3)
Less-experienced	9 (45)	140 (39.7)

^aP < 0.05. ESD: Endoscopic submucosal dissection; MWT: Mallory-Weiss Tear; ESTD: Endoscopic submucosal tunnel dissection.

Table 3 Multivariate analysis for Mallory-Weiss Tear during esophageal endoscopic submucosal dissection

Variable	OR	95%CI	P value
Age	1.037	0.977-1.101	0.229
Sex, female	5.270	1.940-14.320	^a0.001
Procedure time, > 88.5 min	3.953	1.497-10.417	^a0.005

^aP < 0.05.

Table 4 Clinical characteristics of patients who developed Mallory-Weiss Tear during endoscopic submucosal dissection

Patients	Age in yr	Sex	Location	Circumfe-rential of mucosal defect	Procedure time in min	Expert	Endoscopic treatment of MWT	Invasion depth	Submucosal adhesion
Case 1	72	F	M	3/5	60	Y	-	Tis	N
Case 2	61	M	L	3/4	69	Y	-	Tis	N
Case 3	63	F	M	1/2	28	Y	-	Tis	N
Case 4	47	M	L	1/3	45	Y	-	LGIN	N
Case 5	65	F	M	3/4	90	N	-	HGIN	N
Case 6	64	F	M	4/5	98	Y	-	M2	Y
Case 7	51	F	M	4/5	121	Y	E & APC¹	M2	N
Case 8	66	F	M	2/3	125	N	-	Tis	N
Case 9	64	F	M	4/5	175	N	-	Tis	N
Case 10	77	M	L	1	180	N	APC	SM, 550 μm	N
Case 11	60	F	M	1/4	45	N	-	LGIN	N
Case 12	67	F	M	2/3	100	N	APC	SM, 100 μm	N
Case 13	67	M	L	1/2	90	N	-	M3	N
Case 14	57	M	M	5/6	155	N	APC	M2	N
Case 15	69	F	M	1/2	57	Y	Clips	HGIN	Y
Case 16	66	F	M	1/2	40	Y	Clips	Tis	Y
Case 17	67	M	L	1	105	Y	Clips and loop	M2	N
Case 18	65	F	M	2/3	89	Y	-	M2	N
Case 19	64	F	U	1	150	Y	-	M2	N
Case 20	67	F	U	2/3	90	N	-	SM, 220 μm	N

¹Sprinkle of epinephrine solution (1:10000) and argon plasma coagulation treatment in the emergency endoscopy 10 h after endoscopic submucosal dissection. MWT: Mallory-Weiss Tear; Tis: Tumor in situ; LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia; APC: Argon plasma coagulation; M2: Lesion limited to laminae mucosa; SM: Lesion infiltration submucosa; F: Female; M: Male; U: Upper esophagus; M: Middle esophagus; L: Lower esophagus.

Citation: Chen W, Zhu XN, Wang J, Zhu LL, Gan T, Yang JL. Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms. World J Gastroenterol 2019; 25(34): 5174-5184
URL: https://www.wjgnet.com/1007-9327/full/v25/i34/5174.htm
DOI: https://dx.doi.org/10.3748/wjg.v25.i34.5174