Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study
submitted 12 January 2012
accepted after revision 15 June 2012
28 August 2012 (online)
Background and study aims: The frequency of stricture after endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma with a mucosal defect involving more than three-quarters of the circumference is 70 % – 90 %. Stricture decreases quality of life and requires multiple endoscopic balloon dilation (EBD) sessions. We investigated the efficacy and safety of a single session of intralesional steroid injections to prevent post-ESD stricture.
Patients and methods: We conducted a prospective study on 30 patients with esophageal squamous cell carcinoma treated by ESD, who had a more than three-quarter but less than whole circumferential defect. A single session of intralesional steroid injections was undertaken immediately after ESD. Esophagogastroduodenoscopy was performed whenever patients reported dysphagia and 2 months after ESD in patients without dysphagia. Results were compared with a historical control group of 29 patients who underwent ESD without intralesional steroid injection. The primary endpoint was the post-ESD stricture rate. Secondary endpoints were the number of EBD sessions and the complication rate.
Results: Compared with the historical control group, the study group had a significantly lower stricture rate (10 %, 3 /30 patients vs. 66 %, 19 /29 patients; P < 0.0001) and a lower number of EBD sessions (median 0, range 0 – 2 vs. median 2, range 0 – 15; P < 0.0001). The study group had a complication rate of 7 % (2 /30 patients), comprising a submucosal tear in one patient and bleeding in another, which were not a direct result of EBD.
Conclusions: A single session of intralesional steroid injections showed promising results for the prevention of stricture after ESD for esophageal cancer.
- 1 Parkin DM, Bray F, Ferlay J et al. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74-108
- 2 Oyama T, Tomori A, Hotta K et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005; 3: 67-70
- 3 Ono S, Fujishiro M, Niimi K et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 2009; 70: 860-866
- 4 Ono S, Fujishiro M, Niimi K et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy 2009; 41: 661-665
- 5 Katada C, Muto M, Manabe T et al. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc 2003; 57: 165-169
- 6 Mizuta H, Nishimori I, Kuratani Y et al. Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus 2009; 22: 626-631
- 7 Hashimoto S, Kobayashi M, Takeuchi M et al. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 2011; 74: 1389-1393
- 8 Ezoe Y, Muto M, Horimatsu T et al. Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol 2011; 45: 222-227
- 9 Yamaguchi N, Isomoto H, Nakayama T et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 2011; 73: 1115-1121
- 10 Gaujoux-Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis 2009; 68: 1843-1849
- 11 Sarnes E, Crofford L, Watson M et al. Incidence and US costs of corticosteroid-associated adverse events: a systematic literature review. Clin Ther 2011; 33: 1413-1432
- 12 Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis 1989; 11: 954-963
- 13 Ramage Jr JI, Rumalla A, Baron TH et al. A prospective, randomized, double-blind, placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures. Am J Gastroenterol 2005; 100: 2419-2425
- 14 Jalali M, Bayat A. Current use of steroids in management of abnormal raised skin scars. Surgeon 2007; 5: 175-180
- 15 Roques C, Téot L. The use of corticosteroids to treat keloids: a review. Int J Low Extrem Wounds 2008; 7: 137-145
- 16 Takahashi H, Arimura Y, Okahara S et al. Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma. Endoscopy 2011; 43: 184-189
- 17 Rajan E, Gostout C, Feitoza A et al. Widespread endoscopic mucosal resection of the esophagus with strategies for stricture prevention: a preclinical study. Endoscopy 2005; 37: 1111-1115
- 18 Isomoto H, Yamaguchi N, Nakayama T et al. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. BMC Gastroenterol 2011; 11: 46