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Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma.

AbstractBACKGROUND:
Endoscopic submucosal dissection (ESD) permits removal of esophageal epithelial neoplasms en bloc, but is associated with esophageal stenosis, particularly when ESD involves the entire circumference of the esophageal lumen. We examined the effectiveness of systemic steroid administration for control of postprocedural esophageal stricture after complete circular ESD.
METHODS:
Seven patients who underwent wholly circumferential ESD for superficially extended esophageal squamous cell carcinoma were enrolled in this study. In 3 patients, prophylactic endoscopic balloon dilatation (EBD) was started on the third post-ESD day and was performed twice a week for 8 weeks. In 4 patients, oral prednisolone was started with 30 mg daily on the third post-ESD day, tapered gradually (daily 30, 30, 25, 25, 20, 15, 10, 5 mg for 7 days each), and then discontinued at 8 weeks. EBD was used as needed whenever patients complained of dysphagia.
RESULTS:
En bloc ESD with tumor-free margins was safely achieved in all cases. Patients in the prophylactic EBD group required a mean of 32.7 EBD sessions; the postprocedural stricture was dilated up to 18 mm in diameter in these patients. On the other hand, systemic steroid administration substantially reduced or eliminated the need for EBD. Corticosteroid therapy was not associated with any adverse events. Post-ESD esophageal stricture after complete circular ESD was persistent, requiring multiple EBD sessions.
CONCLUSIONS:
Use of oral prednisolone administration may be an effective treatment strategy for reducing post-ESD esophageal stricture after complete circular ESD.
AuthorsHajime Isomoto, Naoyuki Yamaguchi, Toshiyuki Nakayama, Tomayoshi Hayashi, Hitoshi Nishiyama, Ken Ohnita, Fuminao Takeshima, Saburo Shikuwa, Shigeru Kohno, Kazuhiko Nakao
JournalBMC gastroenterology (BMC Gastroenterol) Vol. 11 Pg. 46 (May 04 2011) ISSN: 1471-230X [Electronic] England
PMID21542926 (Publication Type: Journal Article)
Chemical References
  • Anti-Inflammatory Agents
  • Prednisolone
Topics
  • Aged
  • Anti-Inflammatory Agents (therapeutic use)
  • Carcinoma, Squamous Cell (surgery)
  • Catheterization
  • Dissection (adverse effects, methods)
  • Esophageal Neoplasms (surgery)
  • Esophageal Stenosis (drug therapy, etiology, prevention & control, therapy)
  • Esophagoscopy (adverse effects, methods)
  • Esophagus (surgery)
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mucous Membrane (surgery)
  • Prednisolone (therapeutic use)

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