Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: A controlled prospective study

N. Hanaoka, R. Ishihara, Y. Takeuchi, N. Uedo, K. Higashino, T. Ohta, H. Kanzaki, M. Hanafusa, K. Nagai, F. Matsui, H. Iishi, M. Tatsuta, Y. Ito

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Abstract

Background and study aims: The frequency of stricture after endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma with a mucosal defect involving more than three-quarters of the circumference is 70%-90%. Stricture decreases quality of life and requires multiple endoscopic balloon dilation (EBD) sessions. We investigated the efficacy and safety of a single session of intralesional steroid injections to prevent post-ESD stricture. Patients and methods: We conducted a prospective study on 30 patients with esophageal squamous cell carcinoma treated by ESD, who had a more than three-quarter but less than whole circumferential defect. A single session of intralesional steroid injections was undertaken immediately after ESD. Esophagogastroduodenoscopy was performed whenever patients reported dysphagia and 2 months after ESD in patients without dysphagia. Results were compared with a historical control group of 29 patients who underwent ESD without intralesional steroid injection. The primary endpoint was the post-ESD stricture rate. Secondary endpoints were the number of EBD sessions and the complication rate. Results: Compared with the historical control group, the study group had a significantly lower stricture rate (10%, 3/30 patients vs. 66%, 19/29 patients; P<0.0001) and a lower number of EBD sessions (median 0, range 0-2 vs. median 2, range 0-15; P<0.0001). The study group had a complication rate of 7% (2/30 patients), comprising a submucosal tear in one patient and bleeding in another, which were not a direct result of EBD. Conclusions: A single session of intralesional steroid injections showed promising results for the prevention of stricture after ESD for esophageal cancer.

Original languageEnglish
Pages (from-to)1007-1011
Number of pages5
JournalEndoscopy
Volume44
Issue number11
DOIs
Publication statusPublished - Sep 3 2012
Externally publishedYes

ASJC Scopus subject areas

  • Gastroenterology

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    Hanaoka, N., Ishihara, R., Takeuchi, Y., Uedo, N., Higashino, K., Ohta, T., Kanzaki, H., Hanafusa, M., Nagai, K., Matsui, F., Iishi, H., Tatsuta, M., & Ito, Y. (2012). Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: A controlled prospective study. Endoscopy, 44(11), 1007-1011. https://doi.org/10.1055/s-0032-1310107