Abstract:
Objective Based on the Scar-ESD (Scar-endoscopic submucosal dissection) classification, this study aims to explore the safety of re-ESD for early esophageal tumors with scars and evaluate the predictive value of this classification for the operative difficulty.
Methods A retrospective analysis was conducted on the data of patients with early esophageal tumors accompanied by scars from previous treatments who underwent re-ESD at the Digestive Endoscopy Center of Jiangsu Provincial Hospital of Chinese Medicine from February 2017 to February 2024.The safety, dissection rate, intraoperative auxiliary methods, muscular layer injury, specimen damage rate, and treatment outcomes were analyzed.
Results A total of 47 patients were included, with a mean age of 65.51±6.68 years and a male-to-female ratio of 2.6∶1.According to the Scar-ESD classifications, 14 cases (29.79%) were type A0 (without scars), 16 cases (34.04%) were type A1 (with scars), 11 cases (23.40%) were type A2 (with scars), and 6 cases (12.77%) were type A3 (with scars).The median operative time in the A0 group was 17.50 (15.00; 23.75) min, which was significantly shorter than that in the non-A0 group [32.00 (26.00; 45.00)min, P<0.05].The median dissection rate showed no significant difference between the A0 group and the non-A0 group (A1/A2/A3) (P>0.05).Intraoperative traction assistance was used in 14 cases (29.79%) of the non-A0 group (P<0.05), specifically in 5 cases of A1, 5 cases of A2, and 4 cases of A3.Intraoperative muscular layer injury occurred in 22 cases (46.81%), with the highest incidence in types A1 (8 cases) and A2 (8 cases), followed by A3 (5 cases) (P<0.05).Specimen damage occurred in 6 cases (12.77%), with a ratio of 1∶3∶2 in A1/A2/A3 (P=0.05).There were no intraoperative or postoperative perforations or delayed bleeding in all types.The en bloc resection rate was 100% in both the A0 and non-A0 groups.The R0 resection rate and curative resection rate were both 87.23% (41/47).
Conclusion Re-ESD for early esophageal tumors with scars is safe and effective.Types A2/A3 in the Scar-ESD classification has a higher tendency of specimen damage, types A1/A2 is prone to intraoperative muscular layer injury, and non-A0 types may consider intraoperative traction assistance for dissection.The Scar-ESD classification helps predict the operative difficulty, the need for intraoperative auxiliary methods, and specimen damage risk, which provides high clinical utility.
Key words:
Scar-ESD classification,
Scar,
Early esophageal tumor,
Endoscopic submucosal dissection (ESD),
Efficacy
Lijuan Mao, Yiting Huang, Yonggang Ding, Ting Zhang, Tian Jin, Wenjie Li, Xiaoyun Lu, Yaohui Wang, Qide Zhang. Safety and predictive value for operative difficulty of a new classification in re-treatment of scar-associated early esophageal tumors by endoscopic submucosal dissection[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2026, 13(02): 93-100.