Clinical experience of using a novel self‐help inflatable balloon to prevent esophageal stricture after circumferential endoscopic submucosal dissection

Abstract

Although endoscopic submucosal dissection (ESD) is gradually becoming a first‐line treatment for superficial esophageal neoplasms (SEN), strictures occur in almost 100% of cases after circumferential ESD. A standard method to prevent stricture has not been established. Thus, we propose a novel self‐help inflatable balloon to prevent stricture. The new balloon was used by the patients themselves at home (4–5 times a day, duration of each procedure was approximately 15–20 min), and was removed when the defects were almost healed. From January 2018 to September 2018, eight patients who received circumferential ESD for SEN and underwent a novel self‐help inflatable balloon to prevent stricture were enrolled. Median size of the mucosal defects was 76.3 mm (range: 50–90 mm). Median time for removing the self‐help inflatable balloon was 94.6 days (range, 71–119 days). Only one (12.5%) patient experienced stricture, and three endoscopic balloon dilation sessions were carried out for this patient. All patients tolerated the balloon well, and none experienced perforation or delayed bleeding. The self‐help inflatable balloon seems to show a high preventive effect against stricture in patients whose mucosal defect was no longer than 100 mm in length after esophageal circumferential ESD. This method is economic, feasible, and safe.

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

“…Li et al [16] conducted a study on the use of a self-help inflatable balloon to prevent post-ESD stricture. Patients can operate this balloon by themselves at home, which makes the process simple and convenient; additionally, the balloon is reusable.…”

“…Ezoe et al [15] Li et al [16] Yamasaki et al [21] The time required to relieve stricture is short Repeated in a short time, stricture is easy to replapse Perforation, hemorrhage may occur The high cost Esophageal stents…”

Prospective multicenter study of the esophageal triamcinolone acetonide‐filling method in patients with subcircumferential esophageal endoscopic submucosal dissection

“…Some stenosis‐preventive measures have been reported, such as preventive EBD, steroid treatment, temporary stenting, and protective covering with a polyglycolic acid sheet or cultured cell sheet . However, local or oral steroid treatment is the most widely used method based on clinical feasibility .…”

“…4,5 Some stenosis-preventive measures have been reported, such as preventive EBD, steroid treatment, temporary stenting, and protective covering with a polyglycolic acid sheet or cultured cell sheet. [6][7][8] However, local or oral steroid treatment is the most widely used method based on clinical feasibility. 2,3,[9][10][11] Local injection of triamcinolone acetonide (TA) reportedly suppressed the incidence of severe stenosis to 10-19% in patients after esophageal subcircumferential ESD.…”

Stepwise scope bougienage for esophageal stricture after endoscopic submucosal dissection for circumferential lesions

“…Endoscopic submucosal dissection (ESD) for circumferential esophageal cancer inevitably causes a post‐ESD stricture. Although oral prednisolone, local triamcinolone injection and balloon dilation (including a self‐help inflatable balloon) can prevent its formation, a standardized method has not been established . We report a case in which scope bougienage was effective for a post‐ESD stricture in circumferential esophageal cancer.…”