Clinical Analysis Of Circumferential Endoscopic Submucosal Dissection Therapy Of Early Esophageal Cancer

BackgroundEsophageal cancer is one of the most malignant tumors in the world,with high morbidity and mortality and poor prognosis.The etiology of esophageal cancer has not been fully clarified.At present,multiple genes have been found to be associated with the incidence of esophageal cancer,of which the variation of PLCE1 locus on chromosome 10q23 is highly associated with esophageal cancer patients in Taihang Mountain area,a high incidence area of esophageal cancer in China.In addition to genetic susceptibility,the role of environmental factors and personal habits cannot be ignored.Smoking,citing hot tea,drinking,gastroesophageal reflux disease,etc.have also been proved to be the predisposing factors of esophageal cancer.The symptoms of early esophageal cancer are very cryptic,and when typical symptoms such as dysphagia occur,the tumor often has progressed to the middle and advanced stages and the prognosis is poor.Therefore,for patients with risk factors such as family history,regular endoscopic examination should be started in middle age to screen for gastrointestinal malignancies early and obtain a better quality of life.Radical esophagectomy is still the main treatment modality for malignant tumors.Surgical procedures are more invasive,some elderly patients cannot tolerate surgery,and patients also have a lower quality of life after surgery.Moreover,at present,most patients with esophageal cancer in China are diagnosed at an advanced stage and cannot undergo radical surgery.Only radiotherapy,chemotherapy,palliative surgery and other regimens can prolong survival as far as possible,with a very low survival rate and high cost.For esophageal cancer,early screening,early detection of malignant tumors as far as possible and timely and reasonable treatment are important preventive measures to improve the quality of life of esophageal cancer and increase survival rate.Endoscopic submucosal dissection(ESD)for early esophageal cancer has the advantages of minimally invasive,high en bloc resection rate,and few complications.Although studies on ESD techniques have been common in recent years,the safety,efficacy,and complications of treatment are still rarely reported in cases requiring endoscopic esophageal circumferential mucosal dissection for large area lesions.PurposeTo investigate the efficacy and safety of endoscopic circumferential submucosal dissection in patients with large esophageal mucosal lesions;to analyze the incidence of intraoperative and postoperative bleeding,perforation and other complications and subsequent treatment;to analyze the average time interval of each dilatation and other parameters of endoscopic dilatation therapy for postoperative esophageal strictures;to investigate whether direct stent implantation after ESD is effective,as well as the efficacy and safety of repeated endoscopic dilatation followed by stent implantation.Materials and MethodsThe inpatient medical record system of the First Affiliated Hospital of Zhengzhou University was searched.The patients hospitalized for "early esophageal cancer" and"esophageal mucosal dysplasia" from January 2018 to September 2020 were collected.The endoscopic results and pathological reports were examined one by one according to the criteria.41 patients were included for the following study:1.Statistics the clinical basic data of patients,download CT pictures,gastroscopic pictures and other imaging data.2.All cases were divided into direct stent implantation group after ESD,re-stent implantation group after regular dilatation due to stenosis after ESD,and non-stent implantation group according to stent implantation.The operation time,average expansion interval of postoperative endoscopic dilatation,initial expansion time,wound size and other data of each group were calculated,and the differences between the groups were analyzed.3.Using SPSS 26.0 statistical software,the general data of patients were statistically analyzed.Measurement data were expressed as Mean±SD;Mann-Whitney U rank sum test was used for initial dilatation time;paired T-test was used for comparison before and after dilatation interval in halfway stent implantation group.P<0.05 was considered statistically significant.ResultsAmong the 41 patients,23 were males and 18 were females,with an average age of(67.0±6.1)years.Lesions were found to be located in the upper esophagus in 5 cases,middle esophagus in 28 cases,and lower esophagus in 8 cases.Detection rate of enhanced CT was 53.7%.the average length of circumferential defect was 4.5cm.There were 1 patient with delayed postoperative hemorrhage,5 with postoperative fever,1 with intraoperative perforation,1 with perforation in postoperative dilation treatment for esophageal stricture,coupled with the improvement of the complications of esophageal mediastinal fistula after conservative treatment.The incidence rate of esophageal stenosis is 100%.The average length of hospital stay was 9.2d,with the average length of surgery as 171.3min.The first postoperative expansion time and mean expansion interval of the direct stent implantation group(6 patients)were significantly longer than those of the non-stent implantation group(29 patients),and the mean expansion interval of the midway stent implantation group after regular expansion of esophageal stricture after ESD(6 patients),similarly,was also significantly longer than that of the pre-stent implantation group,with statistically significant differences.Fourty-one patients were followed up for 689 days on average,without recurrence.Conclusion1.Endoscopic circumferential therapy for massive premature esophageal cancer is technically safe and effective,with a low incidence of bleeding and perforation,and timely treatment can obtain good results.2.The positive rate of preoperative enhanced CT in circumferential early esophageal cancer can reach 53.7%,while the tumor markers AFP,CA199,CA125 and CEA show no abnormality,which has certain guiding significance for the screening methods of early esophageal cancer.3.After circumferential ESD,the incidence of esophageal stricture reaches 100%,and endoscopic dilatation therapy can relieve stricture symptoms.4.Prophylactic stent implantation or midway stent implantation directly after ESD can achieve intermittent dilatation and improve the quality of life compared with endoscopic dilatation alone.5.Repeated stricture dilatation followed by stent implantation can also obtain good results and has good clinical application value.