LOCAL INJECTION OF TRIAMCINOLONE ACETONIDE WITH SELECTED ADDED ORAL STEROID THERAPY AFTER EXTENSIVE ESOPHAGEAL ESD TO PREVENT STRICTURE: A PROSPECTIVE VALIDATION PROTOCOL IN WESTERN COUNTRIES

Aims Oral steroid is usually administered in Western countries to prevent post-ESD esophageal stricture after extensive resection. A single local injection of triamcinolone acetonide (TA) at the end of ESD has been demonstrated to be effective for resections comprising 50 to 90% of circumference in Japan.

We aim to assess the efficacy of a systematic preventive stricture protocol for esophageal ESD.

Methods Data from esophageal ESD performed in a tertiary European center from January 2016 to October 2021 were prospectively collected. Local TA injection was systematically done for mucosal defect superior to 50% circumference with added oral steroid treatment for more than 90% circumference . Early surgery and post-RFA strictures cases were excluded from the analysis. Symptomatic 28 days stricture rate was evaluated.

Results 92 consecutive patients underwent 105 esophageal ESDs. A median specimen size of 40 [10-130]mm was associated to a 99% en-bloc and 80% R0 resection rate. Circumference resection extension reached less than 50% (50 ESDs), 50 to 90% (48 ESDs) or more than 90% (7 ESDs). Follow-up was available in 91 patients after a median of 599 days [29-1912]. Post-ESD esophageal strictures reached 8.6%, 16% and 20% for global, more than 50% and 75% circumference, respectively . Two patients presented refractory strictures. No adverse events were noted after TA injection.

Conclusions Our systematic preventive protocol after esophageal ESD led to a very low stricture rate, even after extensive resections. Being a single local treatment, it appears beneficial to use this strategy

Publication History

Article published online:
14 April 2022