Clinical Analysis of Esophageal Stricture in Patients Treated with Intralesional Triamcinolone Injection after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer

Abstract

Introduction: Endoscopic submucosal dissection (ESD) has been widely used in the resection of superficial esophageal cancers. Since its use has been extended to cases involving large esophageal tumors occupying nearly the whole or the whole circumference of the lumen, the occurrence of esophageal stricture has increased. Although endoscopic injection of triamcinolone (TA) is widely used for the prevention of postoperative stricture, a significant number of patients still develop stricture after TA injection therapy. Methods: We performed a retrospective study to identify the clinical parameters that predispose post-ESD patients to esophageal stricture after TA injection therapy. Results: A total of 207 patients who were diagnosed with superficial esophageal cancer and subsequently underwent ESD were enrolled in this study. Among these patients, 53 patients and 57 lesions bearing mucosal defects covering greater than two-thirds of the esophageal circumference after ESD were treated with TA injection therapy. The rate of esophageal stricture was found to be highest in cases involving mucosal defects that covered more than seven-eighths of the circumference. Conclusion: Endoscopic TA injection is not sufficient for preventing esophageal stricture in patients bearing mucosal defects covering more than seven-eighths of the esophageal circumference after ESD.

Recent advancements in esophageal cancer treatment in Japan

“…In 2017, Okamoto et al carried out a retrospective study to identify the clinical parameters that predispose post‐ESD patients to esophageal stricture after TA injection therapy. Endoscopic TA injection is not sufficient to prevent esophageal stricture in patients bearing mucosal defects covering more than seven‐eighths of the esophageal circumference after ESD . A randomized phase III trial started in Japan in 2014.…”

PRISMA – Practical meta-analysis of applying local triamcinolone acetonide injection for stenosis after esophageal cancer surgery

“…Currently, esophageal stenosis still occurs even after preventive TA injection, and the reported rate after only one time TA injection was about 17%,31 whereas, no clinical data were found for the stenosis occurrence after two or more times of TA injection. From large-scale retrospective analysis, circumferential extension of mucosal defect >5/6 and 7/8 increased the likelihood of stenosis occurrence after a single preventive TA injection 31,32. Unavoidably, ED was required in the sequence treatment, and current analysis revealed that a combination of ED and TA also showed significant clinical benefits for refractory stenosis (more than three sessions of ED requirement) recurrence.…”

Advances in the prevention and treatment of esophageal stricture after endoscopic submucosal dissection of early esophageal cancer

“…However, a retrospective study suggested that the effect of local injection was unsatisfactory in the prevention of mucosal defects greater than seven-eighths of the esophageal circumference. [34] This method has higher technical requirements, and the injection site must be the submucosa. If the muscular layer is involved, it may lead to complications such as delayed esophageal perforation.…”