Clinical Value Of Endoscopic Submucosal Dissection For Early Hypopharyngeal Lesions And Risk Factors For Delayed Bleeding After ESD For Early Gastric Mucosal Lesions

Part ? Clinical value of endoscopic submucosal dissection in the treatment of early hypopharyngeal carcinoma and precancerous lesionsBackground and objective:With the development of endoscopic diagnosis technology,more and more early hypopharyngeal cancers have been found.At present,the treatment methods of early hypopharyngeal cancer in China are mainly surgery and radiotherapy,and there are few reports about endoscopic submucosal dissection(ESD)in the treatment of early hypopharyngeal cancer.This study retrospectively analyzed the safety and efficacy of ESD in the treatment of early hypopharyngeal cancer.Methods:Clinical data of 46 patients who received ESD for 63 early hypopharyngeal carcinoma and precancerous lesions from Aug 2013 to Aug 2019 in the Department of Endoscopy,Cancer Institute,Chinese Academy of Medical Sciences were retrospectively analyzed.Results:Forty-six patients including 45 males and 1 female with mean age of 59.1 years(38?80 years)were included.46 patients with a total of 62 hypopharyngeal lesions were treated by ESD.There were 27 cases complicated with synchronous esophageal cancer and 8 cases complicated with synchronous esophageal cancer.There were 8 cases with concurrent head and neck tumor and 2 cases with concurrent head and neck tumor.The average length of lesions was(2.7±1.2)cm(0.5?6.8 cm),and the average operation time was(52.3±29.7)min(10?110 min).The result showed that 2 case occurred delayed bleeding after ESD,all of them were successfully recovered by endoscopic treatment.There were no perforation,subcutaneous emphysema or other complications occurred.Pathology results revealed 4 low-grade intraepithelial neoplasia,35 high-grade intraepithelial neoplasia,and 23 squamous cell carcinoma.The en bloc resection rate was 98.3%,and the complete resection rate was 74.2%(46/62 lesions).The follow-up time ranged from 3 to 72 months,with a median of 21 months,and the local recurrence rate was 4.8%(3/62).Conclusions:The application of ESD in the treatment of early hypopharyngeal carcinoma and precancerous lesions is safe,effective and has good clinical application valuePart ? Study of risk factors for delayed bleeding after endoscopic submucosal dissection of gastric carcinoma and precancerous lesions and construction of a predictive model of of postoperative hemorrhage after ESD Background and objective:Endoscopic submucosal dissection(ESD)can effectively remove early gastric cancer and precancerous lesions confined to the mucosal layer and submucosal superficial layer,with less trauma,faster recovery and higher postoperative quality of life,and has gradually become the standard treatment for early gastric cancer and precancerous lesions.However,delayed bleeding after ESD for early gastric cancer and precancerous lesions should also be paid attention to.The aim of the present study was to determine risk factors for post-ESD delayed hemorrhage in patients with gastric epithelial neoplasm and construction of a Nomogram diagram mode.Methods:The date of 637 patients diagnosed as EGC who under resected endoscopically between August 2013 and August 2019 were retrospectively studied.We analyzed the risk factors for bleeding after ESD in relation to the various clinical factors.The R software was used to establish the Nomogram diagram model to predict the post-ESD delayed hemorrhage in patients with gastric epithelial neoplasm.Results:Delayed bleeding in 74 lesions of 699 lesions,the delayed bleeding rate was 10.6%.Univariate analysis showed that operation time ?60 min(P=0.011),poor control of bleeding during ESD(P=0.044),lesion size ?3cm(P=0.003),hypertension after ESD(P<0.05),submucosal fibrosis(P=0.002)and macroscopic type(P<0.05)were significantly related to delayed bleeding.Logistic regression multivariate analysis showed that hypertension after ESD(P<0.05,OR=3.706,95%CI=1.762?5.370),flat type tumor(P=0.014,OR=14.435,95%CI=1.731?120.366),operation time ?60 min(P=0.037,OR=1.773,95%CI=1.036?3.035)and submucosal fibrosis(P=0.032,OR=2.097,95%CI=1.064?4.133)were significantly related to bleeding.The C index of Nomogram plot was 0.729.Calibration plot showed that the predictive model was consistent,and the DC A curve showed satisfactory clinical net benefit.The results of external data verification also show that the model has good predictive value.Conclusions:Our findings suggest that the hypertension of post-ESD,macroscopic type,submucosal fibrosis and treatment time were closely associated with post-ESD delayed hemorrhage.Furthermore,the Nomogram for predicting the post-ESD delayed hemorrhage in patients with gastric epithelial neoplasm based on four independent risk factors has good distinguishing capacity and consistency.The predictive model could help clinicians to identify high risk population and establish appropriate intervention strategies.