Triamcinolone Injection and Shielding with Polyglycolic Acid Sheets and Fibrin Glue for Postoperative Stricture Prevention after Esophageal Endoscopic Resection: A Pilot Study

Sakaguchi, Yoshiki; Tsuji, Yosuke; Fujishiro, Mitsuhiro; Kataoka, Yasufumi; Takeuchi, Chihiro; Yakabi, Seiichi; Saito, Itaru; Shichijo, Satoki; Minatsuki, Chihiro; Asada-Hirayama, Itsuko; Yamaguchi, Daisuke; Niimi, Keiko; Ono, Satoshi; Kodashima, Shinya; Yamamichi, Nobutake; Koike, Kazuhiko

doi:10.1038/ajg.2016.60

Cited by 43 publications

(39 citation statements)

References 9 publications

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“…18, 26, 29, 30 Hybrid therapy using steroid injection and polyglycolic acid sheets may be more efficient at preventing stricture formation than steroid injections alone, even in wholly circumferential cases. 31, 32 Compared with several therapies, 26, 33, 34 a single session of locoregional triamcinolone injection immediately after ESD may be easier, less expensive, and may also demonstrate similar efficacy and safety profiles.…”

Section: Discussionmentioning

confidence: 99%

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

Nagami

Shiba

Ominami

et al. 2017

Clinical and Translational Gastroenterology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Nagami

Shiba

Ominami

et al. 2017

Clinical and Translational Gastroenterology

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“…Moreover, Sakaguchi et al . showed the synergic effect of triamcinolone injection and PGA shielding for near‐circumferential ESD cases with a stricture rate of 11.1% (1/9) . Chai et al .…”

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

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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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“…Yoshiki et al . reported the effectiveness of combining triamcinolone injection and shielding with PGA sheets and fibrin glue for preventing stricture after ESD . The rate of postoperative stricture was 18.2% (2/11).…”

Section: Discussionmentioning

confidence: 99%

Clinical experience of using a novel self‐help inflatable balloon to prevent esophageal stricture after circumferential endoscopic submucosal dissection

Linghu

Chai

et al. 2019

Digestive Endoscopy

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Although endoscopic submucosal dissection (ESD) is gradually becoming a first‐line treatment for superficial esophageal neoplasms (SEN), strictures occur in almost 100% of cases after circumferential ESD. A standard method to prevent stricture has not been established. Thus, we propose a novel self‐help inflatable balloon to prevent stricture. The new balloon was used by the patients themselves at home (4–5 times a day, duration of each procedure was approximately 15–20 min), and was removed when the defects were almost healed. From January 2018 to September 2018, eight patients who received circumferential ESD for SEN and underwent a novel self‐help inflatable balloon to prevent stricture were enrolled. Median size of the mucosal defects was 76.3 mm (range: 50–90 mm). Median time for removing the self‐help inflatable balloon was 94.6 days (range, 71–119 days). Only one (12.5%) patient experienced stricture, and three endoscopic balloon dilation sessions were carried out for this patient. All patients tolerated the balloon well, and none experienced perforation or delayed bleeding. The self‐help inflatable balloon seems to show a high preventive effect against stricture in patients whose mucosal defect was no longer than 100 mm in length after esophageal circumferential ESD. This method is economic, feasible, and safe.

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Triamcinolone Injection and Shielding with Polyglycolic Acid Sheets and Fibrin Glue for Postoperative Stricture Prevention after Esophageal Endoscopic Resection: A Pilot Study

Cited by 43 publications

References 9 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

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

Clinical experience of using a novel self‐help inflatable balloon to prevent esophageal stricture after circumferential endoscopic submucosal dissection

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