PRISMA – Practical meta-analysis of applying local triamcinolone acetonide injection for stenosis after esophageal cancer surgery

Abstract

ObjectivesTo explore the practical method of endoscopic triamcinolone acetonide (TA) injection immediately after endoscopic surgery and combined with endoscopic dilation (ED) in the management of stenosis after esophageal cancer surgery based on their efficacy and safety.MethodsA comprehensive search was performed in electronic databases including MEDLINE, EMBASE, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure for possible controlled studies. Meta-analyses of the included studies were completed using Reviewer Manager software and were reported based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsEight randomized studies and five controlled studies containing 575 patients were obtained. In five studies (n=282), TA injected after surgery reduced the risk of stenosis (risk difference [RD] =−0.51, 95% CI [−0.64, −0.39], P<0.01) and the required ED sessions (RD =−3.66, 95% CI [−5.87, −1.46], P<0.01). In eight studies (n=293), TA injection combined with ED reduced the risk of recurrence of stenosis (RD =−0.28, 95% CI [−0.47, −0.08], P<0.01) and the required ED sessions (RD =−0.71, 95% CI [−1.39, −0.04], P<0.05). TA injection therapy did not increase the risk of complications in seven studies (n=380; RD =−0.01, 95% CI [−0.04, 0.02], P=0.53) compared with control.ConclusionTA injection therapy after esophageal cancer surgery and combined with ED are both effective and safe in the management of stenosis, as they reduce the risk of stenosis and sequentially the required ED sessions without increasing complications.

Transcutaneous injection of triamcinolone acetonide for persistent glottic granulation after laser microsurgery

“… 26 Research shows that TA injection therapy after esophageal cancer surgery and combined with ED (endoscopic dilation) are effective and safe in the management of stenosis. 27 At present, there are no relevant articles on the evaluation of systemic influence on cancer patients regarding the intralesional using of TA. However, no increase in tumor recurrence rate caused by TA has been reported in current reports.…”

Long‐term nutrition alterations after surgery for gastrointestinal cancers

“…Interventional management depends on the location of the stricture, but recent advances have made minimally invasive endoscopic dilatation the mainstay of therapy 53,55 . Balloon dilatation is preferred over solid dilators, 53–55 moreover, dilatation may need to be serial and as often as weekly and adjuncts such as intralesional steroid injection have been used with some success 59 . Endoscopic stent placement is occasionally utilized for patients with recurrent or persistent stricture 60 .…”

“…53,55 Balloon dilatation is preferred over solid dilators, [53][54][55] moreover, dilatation may need to be serial and as often as weekly and adjuncts such as intralesional steroid injection have been used with some success. 59 Endoscopic stent placement is occasionally utilized for patients with recurrent or persistent stricture. 60 Surgical revision in general is not recommended for esophago-gastric or esophago-jejunal anastomosis; however, it may be necessary for intestinal anastomoses that cause persistent nutrition challenges and food intake restriction.…”