Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma

Miwata, Tomohiro; Oka, Shiro; Tanaka, Shinji; Kagemoto, Kenichi; Sanomura, Yoji; Urabe, Yuji; Hiyama, Toru; Chayama, Kazuaki

doi:10.1007/s00464-015-4719-3

Cited by 71 publications

(71 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although several methods of steroid injections have been reported, 10, 11, 12, 13, 14, 18 a single triamcinolone injection immediately after ESD was as effective as the other methods. 11 In addition, it may be easier to recognize, and inject into, the submucosal layer immediately after ESD; therefore, adverse events such as perforation could be avoided.…”

Section: Discussionmentioning

confidence: 81%

“…10, 11, 12 A tumor larger than 75% of the esophageal circumference was reported as a risk factor for refractory stricture formation, 17 even with steroid injection, and a whole-circumference mucosal defect after ESD was difficult to prevent with steroid injection. 14, 17, 18 Therefore, the incidence of stricture formation could be affected by circumference of the lesion or the circumference of the mucosal defect. Although a well-designed, randomized control study would be helpful, it would be difficult to conduct because most patients in the control group would not accept the low quality-of-life associated with dysphagia due to the high incidence of stricture formation.…”

Section: Discussionmentioning

confidence: 99%

“…We did not administer triamcinolone injection therapy alone for cases with whole-circumference mucosal defects because it has been previously reported that locoregional steroid injections have little effect on such cases. 14, 17, 18 We injected a single session of triamcinolone acetonide (Kenacort; Bristol-Myers Squibb, Tokyo, Japan) into the residual submucosal layer of the resected region immediately after ESD. 11, 13 Regardless of the size of the resected specimens, 40 sequential injections of 0.5 ml (2 mg) triamcinolone acetonide were performed for a total of 80 mg.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Single Locoregional Triamcinolone Injection Immediately After Esophageal Endoscopic Submucosal Dissection Prevents Stricture Formation

Nagami

Shiba

Ominami

et al. 2017

Clinical and Translational Gastroenterology

View full text Add to dashboard Cite

Objectives:Although endoscopic submucosal dissection (ESD) is an efficient treatment for superficial esophageal cancer, it is associated with stricture formation after wide-circumference resection that leads to a low quality of life. Although locoregional steroid injections prevent stricture formation, a randomized comparative study did not report any advantages associated with steroid injection. We evaluated the prophylactic efficacy of a single locoregional triamcinolone injection for stricture formation after esophageal ESD.Methods:This was a retrospective matched case-control study using propensity score matching (PSM). Between April 2006 and July 2015, a total of 602 patients with superficial esophageal neoplasia underwent ESD. Among them, 189 patients with mucosal defects that spanned more than 2/3 of the esophageal circumference were included. After exclusion, 150 patients were enrolled. Triamcinolone acetonide (80 mg) was injected into the residual submucosal layer of the resected region immediately after ESD. PSM was performed to reduce the effects of selection bias for steroid injection. The primary outcome was the incidence of stricture formation. The secondary outcome was the number of balloon dilatation procedures required to resolve the stricture formation.Results:Thirty-seven patients, with and without triamcinolone injection each, were matched after PSM. The incidence of stricture formation decreased from 45.9% (17/37) without triamcinolone injection to 18.9% (7/37) with triamcinolone injection (p=0.016). After matching, the mean number of balloon dilatation procedures required also decreased from 2.8±4.6 to 0.6±1.5 times (P<0.01).Conclusions:A single locoregional triamcinolone injection efficiently prevented stricture formation after esophageal ESD.

show abstract

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Single Locoregional Triamcinolone Injection Immediately After Esophageal Endoscopic Submucosal Dissection Prevents Stricture Formation

Nagami

Shiba

Ominami

et al. 2017

Clinical and Translational Gastroenterology

View full text Add to dashboard Cite

show abstract

“…Moreover, postoperative esophageal stricture is one of the main complications associated with large esophageal ESD[23,24]. Muscle layer damage with entire circumferential esophageal ESD has been linked to refractory post-ESD stenosis[25]. Hence, ESD in the esophagus requires a highly skilled endoscopic technique and careful operation, and the provision of a more comfortable environment for ESD will contribute to reductions in complications.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection

Ohara

Toyonaga

Hoshi

et al. 2017

WJG

View full text Add to dashboard Cite

AIMTo investigated the usefulness of a novel slim type ball-tipped FlushKnife (FlushKnife-BTS) over ball-tipped FlushKnife (FlushKnife-BT) in functional experiments and clinical practice.METHODSIn order to evaluate the functionality of FlushKnife-BTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between FlushKnife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using FlushKnife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were analyzed.RESULTSFunctional experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with FlushKnife-BTS was 7.7-fold faster than that with conventional FlushKnife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushKnife-BTS. The waterjet flushing speed was faster with the use of FlushKnife-BT. In clinical practice, a comparison of 6 and 7 ESD using FlushKnife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min (range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with FlushKnife-BTS when the resection size was larger than 1000 m2 (n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15) (P = 0.0065).CONCLUSIONOur results indicate that FlushKnife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspiration and knife insertion during ESD and reducing the frequency of knife removal and reinsertion.

show abstract

“…Endoscopic submucosal dissection is a widely accepted procedure to curative treatment of SESCC limited to the epithelium or lamina propria mucosa (EP/LPM) because LN metastasis is rarely observed in these lesions [2][3][4]. However, LN metastasis is seen in approximately 10% of cases of SESCC with invasion into the muscularis mucosa or mildly into the submucosa (MM/SM1) and in approximately 40% with moderate or deep invasion into the submucosa (SM2/SM3) [5].…”

Section: Introductionmentioning

confidence: 99%

Magnifying Endoscopy with Narrow Band Imaging in Estimating the Invasion Depth of Superficial Esophageal Squamous Cell Carcinomas

Mizumoto¹,

Hiyama

Quach

et al. 2018

Digestion

Self Cite

View full text Add to dashboard Cite

Background/Aim: The aim of this study was to compare the accuracy of magnifying endoscopy with narrow band imaging for the diagnosis of depth of invasion by Japan Esophageal Society (JES) classification and inter- and intraobserver agreement of JES intrapapillary capillary loop (IPCL) classification. Methods: It was a retrospective observational study that has analyzed 136 patients with esophageal malignant neoplasia with magnifying endoscopy narrow band imaging to compare JES’s IPCL classification to the histopathologic findings and to evaluate the inter- and intraobserver agreement. Results: Histopathologic examinations revealed 34 (25.7%) intraepithelial neoplasias, 70 (51.5%) squamous cell carcinomas (SCCs) in the epithelium or with invasion into the lamina propria mucosa, 21 (15.4%) SCCs with invasion into the muscularis mucosa or mild invasion into the submucosa, and 11 (8.1%) SCCs with moderate or deep invasion into the submucosa. IPCL types B1, B2, and B3 also showed high accuracies of 80.8, 83.1, and 94.1%, respectively. The kappa values for inter- and intraobserver agreements of the IPCL classifications were moderate to almost perfect. Conclusions: In the present study, the JES’s IPCL classification has good accuracy to predict the depth of SCC invasion and moderate to almost perfect intra- and interobserver agreements.

show abstract

Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma

Abstract: Our data suggest that refractory post-ESD stenosis occurs after entire circumferential esophageal ESD with muscle layer damage and ≥5 cm of longitudinal mucosal defect length.

Cited by 71 publications

References 25 publications

Single Locoregional Triamcinolone Injection Immediately After Esophageal Endoscopic Submucosal Dissection Prevents Stricture Formation

Single Locoregional Triamcinolone Injection Immediately After Esophageal Endoscopic Submucosal Dissection Prevents Stricture Formation

Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection

Magnifying Endoscopy with Narrow Band Imaging in Estimating the Invasion Depth of Superficial Esophageal Squamous Cell Carcinomas

Contact Info

Product

Resources

About