Management of adverse events related to endoscopic resection of esophageal and gastric neoplasms: Report of consensus meeting

Yamamoto, Yorimasa; Uedo, Noriya

doi:10.1111/den.13386

Cited by 5 publications

(13 citation statements)

References 8 publications

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“…In this study, we found that a single session of 50 mg triamcinolone acetonide local injections into the residual submucosal layer and the resection bed mucosal edges directly after the ESD, for defects extending from 50% to 90% circumference, led to a stricture rate of 8.4% (Supplementary Fig 2). More specifically, for resections regarding defects with more than a 75% circumference, the stricture rate was 25%, a rate that is similar to those reported in other retrospective studies [13,15,25,26]. Comparison with these other studies remains a challenge because of differences in study protocols (triamcinolone dose, number of injections, timing of injection, association or not with oral steroids).…”

Section: Accepted Manuscriptsupporting

confidence: 75%

“…This study demonstrates the efficacy of a systematic prospective protocol to prevent post-ESD esophageal strictures in a Western tertiary center. Without preventive measures, stricture rates can reach 70% to 100% [15], especially when the degree of resection is greater than 75% of the esophageal circumference [3,4,18]. Among the currently used preventive methods, local steroid injection and oral steroids are standard treatments since they have demonstrated efficacy for prevention of strictures and the need for endoscopic balloon dilation [4,12,13,19,20].…”

Section: Discussionmentioning

confidence: 99%

“…The median time before the first dilation session was 43.5 days . The mean number of EBD sessions was 7 [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] with a mean dilation caliber of 18 mm. Three patients failed to achieve 18mm in 3 EBD sessions and were considered to have refractory stenosis.…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…Moreover, systemic steroid treatment can impair wound healing and, therefore, compromise surgical suture healing for possible future complementary surgeries [11]. In Eastern countries, a single round of local triamcinolone acetonide (TA) injections at the end of the procedure has been demonstrated to prevent post-ESD esophageal stricture [11][12][13][14] except in cases of more than 90% circumferential resection [15]. Oral corticosteroids are, therefore, used in addition to TA injection for circumferential resections of 90%-100% [16].…”

Section: Introductionmentioning

confidence: 99%

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Local triamcinolone injection and selective add-on oral steroids to prevent esophageal post-endoscopic submucosal dissection stricture: a retrospective analysis in a Western center

Carpentier,

Englebert,

Otero Sanchez

et al. 2024

Endoscopy

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Background and study aim Extensive esophageal ESDs without preventive measures are at high risk of stricture. Oral steroids and local injection of triamcinolone acetonide have proven to be effective for prevention of esophageal stricture. This study aimed to assess the efficacy of a systematic steroid administration protocol for stricture prevention. Patients and methods A retrospective review of all esophageal ESDs at H.U.B Erasme Hospital (Brussels) between 2016 and 2022 was conducted. Injection of triamcinolone was performed for mucosal defects between 50% and 90% circumference. We added oral corticosteroids for patients with resections of ≥90% circumference . The primary outcome was the incidence of symptomatic stenosis at 3 months. Secondary outcomes were the cumulative stricture rate assessed by endoscopy within 6 months of ESD. Potential risk factors of stricture were evaluated with univariate and multivariate analysis. Results A total of 111 patients underwent 130 esophageal ESDs. Fifty-nine patients received triamcinolone acetonide local injection and 8 patients received local and oral corticosteroids. The primary outcome demonstrated a stricture incidence of 8.4%. The cumulative stricture rate assessed by endoscopy within 6 months of ESD was 10.4%.A mucosal defect of ≥ 6 0 4 0 mm was associated with 15-fold increased risk of stricture. Degree of circumference was also identified as an independent prognostic factor of stricture. Conclusions Our protocol led to a low stricture rate even after extensive resection. As a single session treatment without systemic side effects, triamcinolone injection could provide benefits as a preventive method after large esophageal resection.

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Section: Accepted Manuscriptsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Secondary Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Local triamcinolone injection and selective add-on oral steroids to prevent esophageal post-endoscopic submucosal dissection stricture: a retrospective analysis in a Western center

Carpentier,

Englebert,

Otero Sanchez

et al. 2024

Endoscopy

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“…Bleeding is one of the most common adverse events, 10 and the prevention and management of post‐procedural bleeding (PPB) are necessary for clinicians. Oral anticoagulants, such as direct oral anticoagulants (DOACs) and warfarin, are considered as significant risk factors for PPB 10,11 . DOACs have exhibited better efficacy for the treatment of thrombotic cerebrovascular accidents compared with warfarin, and patients benefit from the convenience of avoiding frequent laboratory monitoring 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Zhu

Tao

et al. 2021

J of Gastro and Hepatol

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Background and Aim Oral anticoagulants are risk factors for post‐endoscopic resection bleeding. We aimed to conduct a systematic review and meta‐analysis for the risks of post‐procedural bleeding (PPB) for direct oral anticoagulants (DOACs) and warfarin following endoscopic resection. Methods Two independent reviewers searched PubMed, Web of Science, Embase, and Cochrane Library. The Newcastle–Ottawa Scale score was used to assess the quality of the studies, the pooled odds ratio (OR) to present PPB results, and the funnel plots to assess publication bias. The Higgins I2 statistic was employed to determine the variation across studies due to heterogeneity. Results We reviewed 30 articles. PPB occurred in 586 patients on DOACs and 1782 on warfarin. The patients on DOACs had a significantly lower overall risk of PPB compared with those on warfarin (OR, 0.867, 95% confidence interval, 0.771–0.975; P = 0.017, I2 = 1.6%). Cumulative meta‐analysis showed that the PPB rate of DOACs has the trend to be lower than that of warfarin with publication year and sample size. For the subgroup of endoscopic submucosal dissection, the PPB of DOACs was significantly lower than that of warfarin (OR, 0.786; 95% confidence interval, 0.633–0.976; P = 0.029, I2 = 0%). No significant difference was observed between DOACs and warfarin for anticoagulant strategies, endoscopic procedures, and lesion location. Conclusions Compared with warfarin, DOACs have the possibility to significantly decrease the risk of PPB following endoscopic resection, especially for endoscopic submucosal dissection.

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Endoscopic Management of Gastric Disruptions

Oza,

Kothari

2023

Preprint

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Gastric perforations and leaks are significant complications that can arise from various gastrointestinal disorders and surgical interventions. Over the past decade, endoscopic techniques have emerged as effective method for managing these conditions. Furthermore, as endoscopic resection techniques have grown in popularity, the risk of acute and delayed perforations has also grown. This review aims to provide an in-depth analysis of the endoscopic management strategies employed in the management of gastric perforations and leaks. We will discuss the etiology, diagnostic modalities, and various endoscopic techniques utilized, and emerging trends in endoscopic management. Our attempt in writing this review paper is to educate and guide clinicians in making informed decisions when faced with gastric perforations and leaks.

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Management of adverse events related to endoscopic resection of esophageal and gastric neoplasms: Report of consensus meeting

Cited by 5 publications

References 8 publications

Local triamcinolone injection and selective add-on oral steroids to prevent esophageal post-endoscopic submucosal dissection stricture: a retrospective analysis in a Western center

Local triamcinolone injection and selective add-on oral steroids to prevent esophageal post-endoscopic submucosal dissection stricture: a retrospective analysis in a Western center

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Endoscopic Management of Gastric Disruptions

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