Analysis Of Long-Term Effect Of Endoscopic Resection In The Treatment Of Early Esophageal Carcinoma And Construction Of Predictive Model Of Esophageal Stricture After Endoscopic Surgery

Background and objective:Currently,endoscopic resection(ER)has been widely used in the treatment for patients with early esophageal cancer(EEC).The preferred choice of ER method for EEC was usually included two methods: Multi-band mucosectomy(MBM)and endoscopic mucosal dissection(ESD).MBM had several advantages of lower risk of complications and simple operation.However,if the diameter of lesion was more than 2 cm,en bloc resection could not be achieved for pathological evaluation with MBM method.ESD could resect the whole lesion for pathological evaluation,but it was associated with a relatively high risk of complications.Therefore,it was necessary to evaluate the effectiveness of these two ER methods on patients with ECC after ER procedure.Additionally,compared with surgical resection,ER has several advantages of less invasion and quick recovery.However,ER also could cause some complications,such as intraoperative bleeding,intraoperative perforation and postoperative esophageal stricture,which might reduce the quality of life and increase their financial burden of patients with EEC.The aim of this study was to establish a clinical predictive model of esophageal stricture after ESD for predicting the probability of esophageal stricture.Methods:The clinical and follow-up data of patients with EEC who underwent ER from November 2010 to October 2021 in our hospital were analyzed retrospectively.The main outcome measurements included the rate of en bloc resection,complete resection,complications esophageal stenosis,tumor residual and tumor recurrence.The risk factors associated with esophageal stricture after ESD was analyzed,and then the nomogram diagram of predictive model was established based on the risk factors.Subsequently,using ROC curve to verify the differentiation of the predictive model of esophageal stricture after ESD,drawing calibration curve to evaluate the calibration of the model,and drawing DCA curve to evaluate the effectiveness of the model.Results:In this study,46 patients with EEC underwent MBM(MBM group),and 205 patients underwent EER(EER group).In the MBM Group,the en bloc resection rate was 4.3%(2/43),and the complete resection rate was 4.3%(2/43).While in the ESD group,the en bloc resection rate was 97.1%(199/205),and the complete resection rate was 92.2%(189/205).These two groups had significant difference in en bloc resection rate(P < 0.001)and complete resection rate(P < 0.001).During hospitalization,2 patients(4.3%)had complications in the MBM group,including 1 with intraoperative hemorrhage and 1 with secondary pulmonary infection.While in the ESD group,12 patients(5.9%)had complications,including 3 with intraoperative perforation and secondary pulmonary infection,1 with intraoperative perforation and delayed hemorrhage,4 with intraoperative hemorrhage,3 with intraoperative perforation,and 1 with secondary pulmonary infection.There was no significant difference in the total complications(P>0.999)between MBM group and EER group.During the follow-up period,2 patients had residual lesion(4.3%),6 had local lesion recurrence(13.0%)and 1 had lesion metastasis(2.2%)in the MBM group.While in the ESD group,9 patients had residual lesion(4.4%),18 had local lesion recurrence(8.8%)and 1 had lesion metastasis(0.5%).There was no significant difference in residual lesion(P>0.999),local recurrence(P=0.541)and lesion metastasis(P=0.807)between the MBM group and the ESD group.Univariate analysis showed: the circumferential range of wounds,the longitudinal diameter of wounds,the depth of tumor invasion and the preventive measures for esophageal stricture after ESD were the risk factors associated with esophageal stricture after ESD.Based on these four risk factors,a clinical prediction model was established for predicting the occurrence of esophageal stricture after ESD.The results of model verification showed that the C-index value of this model was 0.831,and the discrimination was good.The calibration chart also showed that the model had a good calibration,and the DCA curve indicated that the model had good clinical applicability and could better predict postoperative Stenosis occurs.Conclusion:1.Compared with MBM,ESD could improve the rate of en bloc resection and complete resection.Therefore,ESD was a preferential procedure of choice for patients with EEC,which could resect the whole lesion for pathological evaluation.2.Compared with ESD,MBM might not increase the risk of local tumor recurrence or distant metastasis.Therefore,MBM could provide an alternative treatment for patients with EEC.3.The circumferential range of wounds,the longitudinal diameter of wounds,the depth of tumor invasion and the preventive measures for esophageal stricture after ESD were associated with esophageal stricture after ESD.The predictive model could play an applicative role in predicting the esophageal stricture in patients underwent esophageal ESD.