| Research background and ObjectiveChina is one of the countries with a high incidence of esophageal cancer in the world[1,2].With the progress of digestive endoscopy technology,the diagnosis rate of early esophageal cancer and precancerous lesions is constantly improving.Compared with endoscopic mucosal resection(EMR)technology,endoscopic submucosal dissection(ESD)surgery can provide more complete and accurate pathology,and has a wider range of applications.Compared with surgery,ESD has a shorter hospital stay,minimally invasive,and similar efficacy to surgery,which reduces the economic burden of patients and improves postoperative quality of life[3,4].ESD technology has now become the standard treatment for early cancer and precancerous lesions of the esophagus[5].However,postoperative complications should not be ignored,such as delayed bleeding,perforation,esophageal stenosis,pain,etc.,which are not conducive to the promotion and development of endoscopic minimally invasive treatment.As a common postoperative complication after esophageal ESD,non-cardiac chest pain is currently less studied at home and abroad,and the possible risk factors and mechanism are not yet clear.This study retrospectively analyzed the data of 312 patients undergoing esophageal ESD in our hospital,aiming to explore independent risk factors of non-cardiac chest pain after esophageal ESD.MethodThe data of 312 patients who received esophageal ESD treatment due to early esophageal cancer or precancerous lesions in the Digestive Endoscopy Center of the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2020 were selected.The visual analogue scale(VAS)was used to evaluate the pain of patients undergoing esophageal ESD at 12h,24h,and 48h after surgery.Those with chest pain symptoms within 48 hours after operation(excluding other causes such as cardiovascular system,respiratory system or postoperative perforation)and VAS score≥4 were included in the chest pain group,and those without chest pain symptoms or VAS score<4 were included in the non-chest pain group,the clinical data of the two groups were retrospectively analyzed.To compare the general clinical data,lesion characteristics,data related to ESD operation,and postoperative complications of the two groups of patients,the factors with statistical significance were screened out through univariate analysis,and then multivariate logistic regression analysis was conducted for these factors,to screen out independent risk factors.Results1.A total of 280 patients were included in this research,and the incidence of non-cardiac chest pain after esophageal ESD was 35%(98/280).2.In the comparison of clinical general data between the two groups,there were no statistical significance in age,smoking history,drinking history,history of hypertension,family history of esophageal cancer,history of hematological diseases,history of gastrointestinal ESD/EMR,and proportion of postoperative prophylactic oral hormones between the two groups(P>0.05).In the comparison of the lesion characteristics of the two groups of patients,there were no significant differences in lesion site,postoperative pathological diagnosis,proportion of lesion number and ASA classification scores between the two groups of patients(P>0.05).In the comparison of ESD operation between the two groups,there was no statistical significance in the longitudinal length of mucosal extirpated,the range of mucosal defect,the resection rate of whole block,the RO resection rate and the proportion of postoperative complications(P>0.05).3.The univariate analysis demonstrate that the ratio of female patients in the chest pain group(65.31%)was greater than that of the non-chest pain group(38.46%),the proportion of muscularis propria injury(38.78%)was greater than that of the non-chest pain group(8.24%),and the proportion of operation time≥60min(68.37%)greater than that of the non-chest pain group(31.32%),the differences was statistically significant(P<0.05).Multivariate logistic regression analysis showed that women(P<0.001,OR=3.183,95%CI=1.785～5.677),muscularis propria injury(P<0.001,OR=5.212,95%CI=2.522～10.774),and operation time ≥ 60min(P<0.001,OR=3.774,95%CI=2.119～6.722)are independent risk factors for non-cardiac chest pain after esophageal ESD.4.One-way repeated measures analysis of variance showed that the VAS scores in the chest pain group showed a progressive downward trend within 48 hours after surgery.The value of VAS at 12h after surgery(5.21±0.64)was higher than that at 24h after surgery(3.86 ± 0.63)and 48h after surgery(1.51 ± 0.52).The 24h VAS value(3.86 ±0.63)after operation was higher than 48h(1.51 ± 0.52)after operation,and the difference were statistically significant(P<0.05).5.The regression model for non-cardiac chest pain after esophageal ESD is P=1、[1+e(-2.218+1.158 ×(female)+1.65 ×(muscularis propria injury)+1.328×(operating time≥60 minutes))],Hosmer-Lemeshow χ2=3.300,P=0.509,it shows that the difference between the predicted value of the model and the actual observed value is not statistically significant(P>0.05).AUC is 0.797>0.700,95%CI is 0.743～0.851,the Youden index is 0.466,the sensitivity is 79.60%,and the specificity is 67%,its predictive value is good.Conclusions1.Female,presence of muscularis propria injury,and operation time≥60min were independent risk factors for non-cardiac chest pain after ESD.2.Patients with non-cardiac chest pain after esophageal ESD showed a progressive downward trend in the VAS score within 48 hours after the operation,and the chest pain symptom gradually relieved.3.The regression model constructed based on independent risk factors after esophageal ESD has a good predictive effect and has certain clinical guiding significance. |
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