Long-term efficacy and safety of intralesional steroid injection plus oral steroid administration in preventing stricture after endoscopic submucosal dissection for esophageal epithelial neoplasms.

Abstract

Endoscopic submucosal dissection (ESD) has been widely accepted as the treatment for early-stage esophageal epithelial neoplasms. However, stricture is a common complication after large-circumference ESD. This retrospective study is conducted to evaluate the efficacy and safety of intralesional steroid injection plus oral steroid administration in preventing esophageal stricture. 70 patients with a mucosal defect extending over more than two-thirds of the circumference after esophageal ESD for epithelial neoplasms were enrolled in this study. Those who received intralesional triamcinolone injection combined with oral prednisolone administration were assigned to the treatment group, while those who were treated without any prophylaxis of esophageal stricture were assigned to the control group. The primary observation result was the frequency of stricture. The secondary observation results were the number of endoscopic balloon dilation (EBD) sessions and rate of complications. Compared with the control group, the frequency of stricture (14.7% 5/34 patients vs. 51.5% 19/36 patients) and number of EBD sessions (mean 0.2 vs. 3.3) were significantly lower in the treatment group. One patient suffered from perforation in the treatment group and recovered with conservative treatment. None steroid-related complications were found during a long-term follow-up. Intralesional steroid injection plus oral steroid administration is safe and effective in preventing stricture following esophageal ESD for esophageal epithelial neoplasms with a mucosal defect extending no less than two-thirds of the circumference in a long-term follow-up.