Complete Circular Endoscopic Submucosal Dissection Research Articles

Self-help inflatable balloon versus autologous skin-grafting surgery for preventing esophageal stricture after complete circular endoscopic submucosal dissection: a propensity score matching analysis.

The self-help inflatable balloon (SHIB) and autologous skin-grafting surgery (ASGS) were used to prevent stricture after esophageal complete circular endoscopic submucosal dissection (cESD) with promising clinical results. We aim to evaluate which method is more suitable for patients who underwent esophageal cESD. From October 2017 to July 2021, patients whose mucosal defect length were between 30 and 100mm after esophageal cESD were retrospectively reviewed from two prospective studies. They were enrolled once SHIB or ASGS was used as preventive methods to prevent stricture. Propensity score matching (PSM) was used to balance the baseline characteristics between the two groups. Comparisons were made between the two groups, including operation time, the longitudinal length of ulceration, fastingtime, hospitalization days, and the incidence of stricture. A total of 41 patients who met the inclusion criteria were enrolled in the study. The numbers of patients in SHIB group and ASGS group were 25 and 16, respectively. Fifteen patients in each group were selected after performing PSM. The basic baseline characteristics were comparable between the two groups. The stricture rates were 20% (3/15) in SHIB group and 40% (6/15) in ASGS group, while the difference was not statistically significant (p = 0.427). The SHIB group showed significantly shorter operation time, shorter hospitalization days, lower cost, and longer removing balloon/stent time compared with ASGS group (p < 0.001). Comparison of relevant stricture factors between the stricture group and non-stricture group revealed that longer longitudinal length of ulceration (> 60mm) accounted for a higher proportion in stricture groups (p = 0.035). Both the SHIB and ASGS had high efficacy and safety in preventing strictures in patients with mucosal defects no longer than 100mm in length after esophageal cESD. The longitudinal length of ulceration > 60mm was the independent factor for predicting stricture.

Autologous Free Skin Transplantation to Prevent Esophageal Stricture After Complete Circular Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasms

Introduction: Endoscopic submucosal dissection (ESD) of circumferential superficial esophageal neoplasms (SENs) was associated with extremely high rate of postoperative stricture, which decreases the patient’s quality of life substantially. So far, no standard guideline for preventing esophageal stricture in patients after ESD has been established. We aimed to assess the effectiveness and safety of endoscopic transplantation of autologous free skin in preventing stricture formation after circumferential ESD. Methods: A total of 8 patients who underwent circumferential ESD were included in the study. After undergoing ESD, autologous free skin harvested from the right outer thigh of the patient was sewed into a “oversleeve-like” skin and then covered on the outside of a fully-covered esophageal stent. Finally, the stent was placed at the location of the artificial ulcer of esophagus. The stent was removed 4 weeks after the procedure. The patients were followed up with endoscopy at scheduled times. Results: Complete circular ESD and autologous free skin transplantation were successfully performed in all patients. The mean longitudinal diameter of the resected specimens was 98.8 mm (range 70 - 160 mm). The skin grafts grew well and biopsy-proven squamous epithelium with hyperkeratosis at the site of transplant. Five patients (5 / 8, 62.5 %) didn’t experience dysphagia and stricture with a mean follow-up of 4.9 months (range 3 - 8 months). No complications including perforation, bleeding, wound infection, and stent migration were observed during the follow-up. Conclusion: Endoscopic transplantation of free skin could be a safe and effective way of preventing esophageal stricture after circumferential ESD. Long-term follow-up and experience with a large series are needed to further evaluation of this method.352_A Figure 1. Clinical outcomes for 8 patients with early esophageal cancer after circumferential ESD.352_B Figure 2. ESD resulted in a completely circumferential resection. B, The stent was placed on the esophageal ulcer.352_C Figure 3. At endoscopic follow-up 6 months after ESD, the skin graft grew well without any evidence of stricture. A, C: White-light view. B, D: Iodine stain view.

Treatment of long-segment Barrett\u2019s adenocarcinoma by complete circular endoscopic submucosal dissection: a case report

BackgroundWe present the first description of en bloc endoscopic submucosal dissection (ESD) for total circumferential Barrett’s adenocarcinoma, predominantly of the long-segment Barrett’s esophagus (LSBE), with a 2-year follow-up and management strategies for esophageal stricture prevention.Case presentationA 59-year-old man was diagnosed with LSBE and Barrett’s adenocarcinoma by esophagogastroduodenoscopy (EGD). A 55-mm-long circumferential tumor was completely resected by ESD. Histopathology revealed a well-differentiated adenocarcinoma within the LSBE superficial muscularis mucosa. For post-ESD stricture prevention, the patient underwent an endoscopic triamcinolone injection administration, oral prednisolone administration, and preemptive endoscopic balloon dilatation. Two years later, there is no evidence of esophageal stricture or recurrence.ConclusionsESD appears to be a safe, effective option for total circumferential Barrett’s adenocarcinoma in LSBE.

Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer.

Background and aims: Endoscopic submucosal dissection (ESD) was developed in Japan and has been performed on many patients with early stage esophageal cancer; however quality of life in patients with postoperative stricture is drastically decreased and repeat, periodic endoscopic balloon dilatation (EBD) is usually required over long periods. In this study, we evaluate the efficacy of short period, low dose oral prednisolone in controlling post-procedural esophageal stricture. Patients and methods: In total, 33 patients who underwent semicircular or complete circular ESD for esophageal superficial squamous cell carcinoma were included in this study. They were divided into two groups: those who underwent large-circumference ESD with no preventative treatment for stricture (ESD alone group) and those who received systemic steroid treatment for stricture (oral prednisolone group). We compared the two groups in terms of stricture rate and total number of EBD sessions. The ESD alone group underwent no preventative treatment. The oral prednisolone group started with 30 mg/day prednisolone on the second day post-ESD, and continued with a gradually tapering prednisolone dose, finally discontinuing systemic steroid administration 3 weeks later. Results: The stricture rate after ESD was significantly lower in the oral prednisolone group (3 of 17 patients; 17.6 %) than in the ESD alone group (11 of 16 patients; 68.7 %) (P < 0.01). The number of EBD sessions was significantly lower in the oral prednisolone group than in the ESD alone group (median 4.6, range 2 – 10 vs. median 8.1, range 1 – 18; P < 0.01). Conclusion: Short period, low dose oral prednisolone showed promising results for the prevention of stricture after ESD for early stage esophageal cancers.

When is pre-emptive treatment necessary after endoscopic mucosal resection of early esophageal neoplasm?

When is pre-emptive treatment necessary after endoscopic mucosal resection of early esophageal neoplasm?

Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma

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.

Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma

Endoscopic submucosal dissection (ESD) permits en bloc removal of superficial esophageal squamous cell carcinoma. However, postprocedure stricture is common after ESD for extensive tumors, and multiple endoscopic balloon dilation (EBD) is required for recalcitrant cases. To evaluate the effectiveness of oral prednisolone in controlling postprocedure esophageal stricture. Retrospective study. Endoscopy department at a university hospital. Patients who underwent complete circular or semicircular ESD for esophageal squamous cell carcinoma involving more than three fourths of the lumen were treated with either pre-emptive EBD or oral prednisolone. Preemptive EBD was started on the third day post-ESD and continued twice weekly for 8 weeks. Oral prednisolone was started at 30 mg/day on the third day post-ESD , tapered gradually, and then discontinued 8 weeks later. An additional EBD was performed on demand in both groups whenever dysphagia appeared. The incidence of esophageal stricture and number of EBD sessions required to relieve dysphagia. Stricture at 3 months after ESD was found in 7 of 22 patients in the preemptive EBD group but only 1 of 19 in the oral prednisolone group (P < .05). The average number of EBD sessions required was 15.6 in the preemptive EBD group and 1.7 in the oral prednisolone group (P < .0001). After complete circular ESD, 32.7 EBD sessions were needed on average in the preemptive EBD group, whereas fewer were needed in the oral prednisolone group (P < .05). Nonrandomized study. Post-ESD esophageal strictures were persistent even if treated preemptively with multiple EBD sessions, but oral prednisolone may offer a useful preventive option.