Management and risk factor of stenosis after endoscopic submucosal dissection for colorectal neoplasms

Stenosis after colorectal endoscopic submucosal dissection: When to expect, how to manage?

“…20 Four (0.49%) of 822 patients developed stenosis after ESD. 20 There were no documented strictures where less than 90% of the colorectal circumference was resected. 20 Post-ESD stenosis was observed in 11.1% of patients with subtotal resection (more than 90% but less than 100% of circumference) and in 50% of patients with total (100%) circumferential resection.…”

“…20 There were no documented strictures where less than 90% of the colorectal circumference was resected. 20 Post-ESD stenosis was observed in 11.1% of patients with subtotal resection (more than 90% but less than 100% of circumference) and in 50% of patients with total (100%) circumferential resection. 20 All patients were treated successfully with endoscopic dilation, and only 1 patient required additional local administration of steroids.…”

“…20 All patients were treated successfully with endoscopic dilation, and only 1 patient required additional local administration of steroids. 20 What can we learn from this study? First, it appears that the rectum is a more "forgiving" space than the esophagus and stomach; even resection of up to 90% of the rectal circumference did not cause the development of strictures, and resection between 90% and 100% of the circumference had only a modest (11.1%) risk of subsequent stricture formation.…”

“…Only 2 previous full-length publications addressed the rate of stenosis after rectal ESD; although the first study 18 (69 rectal tumors occupying over 75% of rectal circumference) demonstrated a very high risk of post-ESD rectal strictures (71.4% after total circumferential resection and 43.8% after subtotal [over 90% of circumference] resection), the second study observed rectal stenosis only in 1 (4.2%) clinically asymptomatic patient. 19 The study by Hayashi et al 20 in the current issue of Gastrointestinal Endoscopy summarized a 12-year (2003-2015) single-center experience of 822 patients with 912 consecutive colorectal lesions. 20 Four (0.49%) of 822 patients developed stenosis after ESD.…”

“…First, it appears that the rectum is a more "forgiving" space than the esophagus and stomach; even resection of up to 90% of the rectal circumference did not cause the development of strictures, and resection between 90% and 100% of the circumference had only a modest (11.1%) risk of subsequent stricture formation. 20 By contrast, total circumferential resection carries a significant risk (50%) of subsequent rectal stricture. 20 The lower rate of rectal post-ESD strictures is most likely due to the larger diameter of the rectum (compared with the esophagus, cardia, or pylorus) and a stronger muscle wall forcing formed stool through the stenotic area.…”