Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study

Endoscopy. 2012 Nov;44(11):1007-11. doi: 10.1055/s-0032-1310107. Epub 2012 Aug 28.

Abstract

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.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / surgery*
  • Endoscopy, Digestive System
  • Endoscopy, Gastrointestinal* / methods
  • Esophageal Neoplasms / surgery*
  • Esophageal Stenosis / prevention & control*
  • Female
  • Humans
  • Injections, Intralesional
  • Male
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Triamcinolone Acetonide / administration & dosage*

Substances

  • Triamcinolone Acetonide