Abstract
BackgroundEndoscopic submucosal dissection (ESD) permits removal of esophageal epithelial neoplasms en bloc, but is associated with esophageal stenosis, particularly when ESD involves the entire circumference of the esophageal lumen. We examined the effectiveness of systemic steroid administration for control of postprocedural esophageal stricture after complete circular ESD.MethodsSeven patients who underwent wholly circumferential ESD for superficially extended esophageal squamous cell carcinoma were enrolled in this study. In 3 patients, prophylactic endoscopic balloon dilatation (EBD) was started on the third post-ESD day and was performed twice a week for 8 weeks. In 4 patients, oral prednisolone was started with 30 mg daily on the third post-ESD day, tapered gradually (daily 30, 30, 25, 25, 20, 15, 10, 5 mg for 7 days each), and then discontinued at 8 weeks. EBD was used as needed whenever patients complained of dysphagia.ResultsEn bloc ESD with tumor-free margins was safely achieved in all cases. Patients in the prophylactic EBD group required a mean of 32.7 EBD sessions; the postprocedural stricture was dilated up to 18 mm in diameter in these patients. On the other hand, systemic steroid administration substantially reduced or eliminated the need for EBD. Corticosteroid therapy was not associated with any adverse events. Post-ESD esophageal stricture after complete circular ESD was persistent, requiring multiple EBD sessions.ConclusionsUse of oral prednisolone administration may be an effective treatment strategy for reducing post-ESD esophageal stricture after complete circular ESD.
Highlights
Endoscopic submucosal dissection (ESD) permits removal of esophageal epithelial neoplasms en bloc, but is associated with esophageal stenosis, when ESD involves the entire circumference of the esophageal lumen
We report on 7 consecutive patients with superficial esophageal squamous cell carcinoma (SCC) who underwent wholly circumferential ESD
Excised specimens were fixed in 10% buffered formalin, paraffin-embedded, Table 1 Clinicopathological features and treatment measures for esophageal stricture for 7 patients with esophageal squamous cell carcinoma treated by complete circular endoscopic submucosal dissection
Summary
Endoscopic submucosal dissection (ESD) permits removal of esophageal epithelial neoplasms en bloc, but is associated with esophageal stenosis, when ESD involves the entire circumference of the esophageal lumen. ESD has an advantage over endoscopic mucosal resection (EMR) for removing gastrointestinal tumors en bloc, regardless of their size [1,2]. Several studies in advanced institutes showed that ESD was promising for superficial esophageal epithelial neoplasms with nominal risks for nodal or distant metastasis [4,5]. The exact incidence of luminal stricture after esophageal ESD is unknown, it is related to the extent of the circumference being resected [6]. Esophageal stricture occurs commonly following ESD involving the entire circumference of the esophageal lumen [6]. The resultant dysphagia substantially decreases patients’ quality of life (QOL), requiring multiple sessions of endoscopic balloon dilatation (EBD) [7]
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