Prevention of Esophageal Stricture After Endoscopic Submucosal Dissection: A Systematic Review

Yu, Jiangping; Liu, Yongjun; Tao, Yunxia; Ruan, Rongwei; Zhao, Chunhe; Zhu, Shuwen; Wang, Shi

doi:10.1007/s00268-015-3193-3

Cited by 29 publications

(20 citation statements)

References 46 publications

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“…Esophageal stricture is the most frequent complication associated with near-or whole-circumferential ESD for such large superficial esophageal cancers. Since esophageal stricture sometimes worsens quality of life, various preventive methods have been proposed [4,7,10] . Endoscopic injection of TA is widely used in the prevention of esophageal stricture associated with ESD [8,9] .…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic intralesional injection of triamcinolone (TA) is widely used for the prevention of esophageal stricture after ESD. Although endoscopic TA injection can cause delayed perforation upon injection into the muscle layer [6,7] , several clinical studies report the safety and efficacy of its use [8,9] . It should be noted, however, that a significant proportion (10-20%) of patients still develop postoperative esophageal stricture even after treatment with endoscopic TA injection [8,9] .…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

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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“…Additional surgical resection cases with residual tumors after ESD, and non-additional resection cases with recurrence after ESD. However, previous studies described the safety of ESD; and the indication for ESD has gradually been expanded to larger and deeper tumors (1,2,10,11). In Japan, EC has been approved as an indication for ESD under health insurance coverage since 2008.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Additional Surgical Resection After Endoscopic Submucosal Dissection for Superficial Esophageal Cancer

2017

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“…Dilatation surgery using a scaffold patch was recently reported to be safe and effective in small numbers of patients 24. Despite these procedures being invasive and having limited efficacy, they are required to overcome developed refractory esophageal strictures 25.…”

Section: Discussionmentioning

confidence: 99%

Transplantation of epidermal cell sheets by endoscopic balloon dilatation to avoid esophageal re-strictures: initial experience in a porcine model

et al. 2016

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Background and study aims: Epidermal cell sheet (ECS) transplantation immediately after aggressive endoscopic submucosal dissection (ESD) has been shown to be safe and effective in the prevention of esophageal strictures. This study evaluated the feasibility of ECS transplantation after endoscopic balloon dilation (EBD) in a porcine model. Methods: Six pigs underwent circumferential esophageal ESD under general anesthesia. Two weeks later, two pigs underwent EBD and transplantation of an autologous ECS, two underwent EBD alone, and two underwent endoscopic observation only (control). Results: The two pigs in the transplantation group underwent six ECS transplants after EBD with five of the six (83 %) being successful, as shown by engraftment of transplanted ECSs after 7 days. No adverse events were observed. Stricture rates were lower in the two transplanted pigs (55 % and 60 %) than in the control (92.2 % and 87.7 %) and EBD-treated (71.7 % and 78.2 %) pigs. Infiltration of inflammatory cells was significantly lower in the transplanted pigs than in the control and EBD-treated pigs. Conclusion: Preliminary results indicate the stability of the ECS transplantation procedure and the engraftment of transplanted ECS in the tears after EBD. This proof-of-concept study suggests that covering tears with ECSs after EBD may avoid re-strictures.

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Prevention of Esophageal Stricture After Endoscopic Submucosal Dissection: A Systematic Review

Abstract: Until a safer and more effective method is developed, our review supports the use of corticosteroids, either through injection or oral route, together with endoscopic dilatation in prevention of post-ESD strictures.

Cited by 29 publications

References 46 publications

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

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

Efficacy of Additional Surgical Resection After Endoscopic Submucosal Dissection for Superficial Esophageal Cancer

Transplantation of epidermal cell sheets by endoscopic balloon dilatation to avoid esophageal re-strictures: initial experience in a porcine model

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