Local triamcinolone injection and selective add-on oral steroids to prevent post-ESD esophageal stricture: retrospective analysis of a prospective protocol in a Western center.

Abstract

Background and study aim Extensive esophageal ESDs without preventive measures are at high risk of stricture. Oral steroids and local injection of triamcinolone acetonide have proven to be effective for prevention of esophageal stricture. This study aimed to assess the efficacy of a systematic steroid administration protocol for stricture prevention. Patients and methods A retrospective review of all esophageal ESDs at H.U.B Erasme Hospital (Brussels) between 2016 and 2022 was conducted. Injection of triamcinolone was performed for mucosal defects between 50% and 90% circumference. We added oral corticosteroids for patients with resections of ≥90% circumference . The primary outcome was the incidence of symptomatic stenosis at 3 months. Secondary outcomes were the cumulative stricture rate assessed by endoscopy within 6 months of ESD. Potential risk factors of stricture were evaluated with univariate and multivariate analysis. Results A total of 111 patients underwent 130 esophageal ESDs. Fifty-nine patients received triamcinolone acetonide local injection and 8 patients received local and oral corticosteroids. The primary outcome demonstrated a stricture incidence of 8.4%. The cumulative stricture rate assessed by endoscopy within 6 months of ESD was 10.4%.A mucosal defect of ≥ 6 0 4 0 mm was associated with 15-fold increased risk of stricture. Degree of circumference was also identified as an independent prognostic factor of stricture. Conclusions Our protocol led to a low stricture rate even after extensive resection. As a single session treatment without systemic side effects, triamcinolone injection could provide benefits as a preventive method after large esophageal resection.