Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer

Kataoka, Masao; Anzai, Sho; Shirasaki, Tetsuya; Ikemiyagi, Hidekazu; Fujii, Takashi; Mabuchi, Kazuhisa; Suzuki, Shinji; Yoshida, Masashi; Kawai, Takashi; Kitajima, Masaki

doi:10.1055/s-0034-1390797

Cited by 58 publications

(77 citation statements)

References 23 publications

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“…In this study, the oral steroid group showed a significantly lower stricture rate than the other two groups when the mucosal defect affected >75% of the circumference of the esophagus. This result is consistent with the results of other studies reporting the effectiveness of oral steroids in preventing post‐ESD strictures . In those studies, a stricture was defined as either the complaint of dysphagia or inability to pass an endoscope, or the inability to pass an endoscope with an outer diameter of 9.8 mm through the esophagus .…”

Section: Discussionsupporting

confidence: 90%

“…This result is consistent with the results of other studies reporting the effectiveness of oral steroids in preventing post‐ESD strictures . In those studies, a stricture was defined as either the complaint of dysphagia or inability to pass an endoscope, or the inability to pass an endoscope with an outer diameter of 9.8 mm through the esophagus . Circumferential defects in patients included in those studies were complete circumferential ESD in some and >75% of the lumen in others .…”

Section: Discussionsupporting

confidence: 88%

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Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

Pih

Kim

Gong

et al. 2019

J of Digest Diseases

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Objectives This study aimed to investigate the efficacy of prophylactic steroid administration in preventing post‐endoscopic submucosal dissection (ESD) esophageal stricture and to determine risk factors for these strictures. Methods Patients who underwent ESD for superficial esophageal neoplasms with a mucosal defect affecting >75% of the esophageal circumference between January 2011 and August 2016 were eligible. Patients were classified into three groups, including ESD‐alone group (n = 22), oral steroid group (n = 25) and intralesional steroid injection group (n = 6). Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors for esophageal stricture. Results The stricture rate was 50.0%, 20.0% and 33.3% in the ESD‐alone group, oral steroid group and steroid injection group, respectively. Patients treated with steroids had a significantly lower stricture rate than the ESD‐alone group (22.6% vs 50.0%, P = 0.046). Additionally, oral steroid group had a significantly lower stricture rate than the ESD‐alone group (P = 0.037). Multivariate analysis revealed that the extent of the circumferential mucosal defect was a significant risk factor for post‐ESD strictures (odds ratio [OR] 13.015, 95% confidence interval [CI] 2.257‐76.077, P = 0.004). The administration of steroids (OR 0.108, 95% CI 0.020‐0.578, P = 0.009), specifically oral steroids (OR 0.109, 95% CI 0.019‐0.622, P = 0.013), was associated with prevention of post‐ESD strictures. Conclusion Oral steroid prophylaxis appears to be a safe and effective treatment in preventing post‐ESD stricture and improving patients' quality of life.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

Pih

Kim

Gong

et al. 2019

J of Digest Diseases

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“…In line with this, another report showed that the percentage of postoperative stricture after application of PGA sheets was 7.7% in patients with a mucosal defect covering greater than seven-twelfths of the esophageal circumference [14] . Furthermore, Kataoka et al [15] reported a case in which esophageal stricture was successfully prevented by endoscopic TA injection followed by the application of PGA sheets after a whole-circumferential resection. Therefore, it is important to consider alter- Representative case with esophageal stricture after ESD and TA injection.…”

Section: Discussionmentioning

confidence: 99%

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

Okamoto¹,

Matsui²,

Watanabe³

et al. 2017

Oncology

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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.

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“…Efficacy of systemic (oral) steroids to decrease incidence of post‐ESD strictures was reported in three observational studies (Table ) . Although these small retrospective studies described no severe adverse events, long‐term systemic steroid therapy may cause adverse events.…”

Section: Management Of Adverse Events Related To Esophageal Esdmentioning

confidence: 99%

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Yamamoto

Kikuchi

Nagami

et al. 2019

Digestive Endoscopy

101

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Prevention therapy is recommended for lesions >1/2 of the esophageal circumference. Locoregional steroid injection is recommended for lesions >1/2–3/4 of the esophageal circumference and oral steroids are recommended for lesions >1/2 of the subtotal circumference. For lesions of the entire circumference, oral steroid combined with injection steroid is considered. Endoscopic balloon dilatation (EBD) is the first choice of treatment for stricture after esophageal endoscopic submucosal dissection (ESD). Radical incision and cutting or self‐expandable metallic stent can be considered for refractory stricture after EBD. In case of intraoperative perforation during esophageal ESD, endoscopic clip closure should be initially attempted. Surgery is considered for treatment of delayed perforation. Current standard practice for prevention of delayed bleeding after gastric ESD includes prophylactic coagulation of vessels on post‐ESD ulcers and giving proton pump inhibitors. Chronic kidney disease stage 4 or 5, multiple antithrombotic drug use, anticoagulant use, and heparin bridging therapy are high‐risk factors for delayed bleeding after gastric ESD. Intraoperative perforation during gastric ESD is initially managed by endoscopic clip closure. If endoscopic clip closure is difficult, other methods such as over‐the‐scope clip (OTSC), polyglycolic acid (PGA) sheet shielding etc. are attempted. Delayed perforation usually requires surgical intervention, but endoscopic closure by OTSC or PGA sheet may be considered. Resection of three‐quarters of the circumference is a risk factor for stenosis after gastric ESD. Giving prophylactic local steroid injection and/or oral steroid is reported, but effectiveness has not been fully verified as has been done for esophageal stricture. The main management method for gastric stenosis is EBD but it may cause perforation.

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Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer

Cited by 58 publications

References 23 publications

Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

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

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

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