Effect of Oral Prednisolone on Esophageal Stricture after Complete Circular Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Carcinoma: A Case Report

Abstract

A 74-year-old man with nausea underwent upper gastrointestinal endoscopy, and a 0-IIb type tumor was found in the middle thoracic esophagus. Histological examination with endoscopic biopsies revealed squamous cell carcinoma (SCC), and chromoendoscopy with iodine staining revealed that the superficial SCC involved nearly the entire circumference of the esophageal lumen. There were neither nodal nor distant metastases. Complete circular endoscopic submucosal dissection (ESD) was successfully achieved with tumor-free margins in an en bloc fashion. The histopathological examination confirmed a diagnosis of intramucosal invasive carcinoma limited to the lamina propria mucosae without angiolymphatic invasion. Oral prednisolone was started with 0.5 mg/kg daily on the 3rd post-ESD day, tapered gradually, and then discontinued 8 weeks later without adverse effects. There were no complaints of dysphagia following ESD. On follow-up endoscopy with iodine staining, which was scheduled at 1, 3 and 6 months after ESD, there was no postprocedural esophageal stricture, and neither recurrent nor metachronous lesions were found. Thus, the patient required no sessions of endoscopic balloon dilatation. At the last outpatient clinic visit 7 months after ESD, he remained well without dysphagia. Oral prednisolone administration may offer an effective therapeutic strategy to prevent the post-ESD esophageal stricture after complete circular ESD.

Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer

“…With this regimen, there were no complaints of dysphagia after ESD. [20][21][22][23] In this study, at a median follow-up of 12 months (range 3-27 months), all cases of curative resection revealed neither local recurrence nor distant metastasis, including one case defined as a GI stromal tumor. The histopathology of tumors of the esophageal muscularis propria in our series generally reveals that they are benign leiomyomas or small stromal tumors.…”

Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

“…Post-ESD stricture can be successfully managed with EBD [33]. Local injection or oral administration of steroids was recently reported as an effective strategy for preventing post-ESD stricture [38][39][40][41][42][43]. Among patients with symptoms, five patients were successfully managed with EBD performed in a median of 1.6 sessions (range, 1 to 3).…”

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

“…Recently, systemic steroid administration has been reported to be effective for post-EBD stricture and might resolve the problems of EBD, such as multiple EBD sessions reducing the patient's quality of life and increasing the risk of esophageal perforation [53] . Isomoto et al [54] described seven patients with superficial SCC who underwent completely circumferential ESD.…”