512. Combinational Treatment Using Endoscopic Dilation and Oral Prednisolone for Refractory Anastomotic Stricture After Esophagectomy

Abstract

Anastomotic strictures are common complications after esophagectomy, and frequent dilatations to refractory strictures reduce patient’s QOL. Yamaguchi and colleagues have developed new treatments using oral prednisolone. They have shown the safety and potential efficacy to prevent esophageal strictures after ESD. However, the efficacy and safety of oral prednisolone is not evaluated to anastomotic stricture after esophagectomy. The aim of this study is to examine the safety of oral steroids therapy for postoperative esophageal stenosis. The subjects were patients who passed 28 days after the esophagectomy and recurred stenosis symptoms within 2 weeks after the dilatation, and who have undergone more than three or more dilations. Indication of oral steroids therapy was based on the definition of Kochman. Oral prednisolone was started at 30 mg/day after dilations, tapered gradually, and then discontinued for 12 weeks. The primary endpoint was safety evaluation. Secondary endpoints included stenosis rate at 85 days after initiation of steroid therapy, dysphagia score, number of dilations, change in weight, and duration of dilation interval, and enterostomy use rate. Five of six patients with refractory anastomotic strictures were enrolled. The risk factor for the incidence of refractory stenosis was ischemic changes around the entire anastomosis. The duration of hospital stay was significantly prolonged. All the patients completed the therapy and no adverse events were observed. There were two cases of re-strictures. Dilation frequency was significantly reduced (4.4 ± 1.1 vs. 1.4 ± 1.9, P < 0.01) and the intervals was significantly prolonged (11.9 ± 6.2 days vs. 60.5 ± 33.6 days, P = 0.02). Dysphagia scores were significantly improved (3.2 ± 0.8 vs 0.2 ± 0.4, P < 0.01). The rate of enterostomy use was significantly reduced (80% vs 0%, P = 0.02). Steroid therapy for esophageal stricture after esophagectomy may be safe and effective. Further studies are needed to evaluate the efficacy of steroid therapy in a large number of patients.