Effectiveness Of Endoscopic Submucosal Dissection For Esophageal High-grade Intraepithelial Neoplasia

Objective : To investigate the risk factors for non-curative resection of esophageal high-grade intraepithelial neoplasia(HGIN)using endoscopic submucosal dissection(ESD).Methods: We retrospectively reviewed the information from 92 patients who underwent ESD for HGIN at JiangSu Provience Hospital from December 2012 to April 2015.The clinical manifestation,endoscopic appearance and histopathological information were collected and the risk factors for non-curative resection after ESD were analyzed.All the enrolled patients were divided into curative resection group(79)and non-curative resection group(13)according to the pathological results after ESD.The risk factors for discrepancy between the curative resection group and non-curative resection group were analyzed.Results: Among the enrolled 92 patients,the overall en bloc resection rate was 100%,the complete resection rate 85.9% and the curative resection rate 85.9%.There were no significant differences in demographics,endoscopic and histopathologic features between the curative resection group and non-curative resection group,including gender(P=0.273),age(P=0.220),tumor location(P=0.389),erythema(P=0.285),erosion(P=0.830),nodularity(P=0.254),number of biopsy(P=0.679)and macroscopic pattern(P=0.511).The data of the cases including the lesion size >2 cm(?2=6.891,P=0.009),with whitish fur(?2=9.291,P=0.002),submucosa invasion(?2=9.291,P=0.002)and Lugol unstained(?2=10.408,P=0.015)were significant more frequently in the non-curative resection group than in the curative resection group.Further multivariate regression analysis demonstrated that the lesion size >2 cm(OR=6.737,95%CI:1.443-31.454,P=0.015),submucosa invasion(OR=8.333,95% CI:1.771-39.215,P=0.007)and Lugol unstained(OR=1.996,95% CI:1.233-6.230,P=0.005)of focus as independent risk factors for non-curative resection.Conclusion: For esophageal HGIN patients,risk factors like lesion size,submucosa invasion and ulceration should be taken into account before preparing ESD.