Topical oro-dispersible budesonide tablets for stricture prevention after near circumferential ESD for esophageal squamous cell cancer – a case report

Abstract

Background Endoscopic resection is the treatment of choice for early esophageal cancers. However, resections comprising more than 70–80 % of the circumference are associated with a high risk of stricture formation. Currently, repetitive local injections and/or systemic steroids are given for prevention.

Case report We present here the case of a 78-year-old male patient who had a near circumferential endoscopic submucosal dissection for a pT1a mm, L0, V0, R0, G2 esophageal squamous cell cancer. At the end of endoscopic resection, 80 mg of triamcinolone was injected locally. The patient was then treated with oro-dispersible budesonide tablets (2 × 1 mg/day) and nystatin (4 × 100 000 I.E.) for 8 weeks. This treatment resulted in complete healing without any stricture formation and did not result in any complications.

Discussion Treatment with orodispersible budesonide tablets could help prevent strictures after large endoscopic resections in the esophagus.

Zusammenfassung

Hintergrund Die endoskopische Resektion von Ösophagusfrühkarzinomen ist der aktuelle Therapiestandard. Allerdings sind Resektionen von mehr als 70–80 % der Zirkumferenz mit einem sehr hohen Strukturrisiko behaftet. Aktuell werden zur Prävention wiederholte lokale Steroidinjektionen und/oder systemische Steroide eingesetzt.

Fallbericht Wir berichten über einen 78-jährigen Mann, bei dem wegen eines Plattenepithelfrühkarzinoms (pT1a mm, L0, V0, R0, G2) eine subtotal zirkumferentielle endoskopische Submukosadissektion durchgeführt worden war. Am Ende der Resektion wurde einmalig 80 mg Triamcinolon lokal injiziert. Anschließend wurde über 8 Wochen mit oro-dispersiblen Budesonid Tabletten (2 × 1 mg) und Nystatin (4 × 100 000 I.E.) behandelt. Diese Therapie führte zu einer kompletten Ausheilung ohne Ausbildung einer Striktur. Komplikationen wurden nicht beobachtet.

Schlussfolgerung Die Therapie mit orodispersiblen Budesonid Tabletten könnte zur Prävention von Strikturen nach ausgedehnten endoskopischen Resektionen im Ösophagus hilfreich sein.

Key words

early esophageal cancer - endoscopic submucosal dissection - stricture prevention - topical steroids budesonide

Schüsselwörter

Ösophagusfrühkarzinom - endoskopische Submukosadissektion - Prävention von Strikturen - topische Steroide - Budesonid

Publication History

Received: 18 January 2021

Accepted: 02 March 2021

Article published online:
18 March 2021

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