A Pilot Study of Scheduled Endoscopic Balloon Dilation With Oral Agent Tranilast to Improve the Efficacy of Stricture Dilation After Endoscopic Submucosal Dissection of the Esophagus

Uno, Kaname; Iijima, Katsunori; Koike, Tomoyuki; Abe, Yatsuhiko; Asano, Naoki; Ara, Nobuyuki; Shimosegawa, Tooru

doi:10.1097/mcg.0b013e31824fff76

Cited by 38 publications

(41 citation statements)

References 38 publications

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“…Furthermore, the use of EBD with other agents has also been investigated. Using EBD together with the oral agent tranilast or applying steroid gel has reportedly reduced the esophageal stricture rate . Further studies should be conducted to evaluate the efficacy of each material and method.…”

Section: Discussionmentioning

confidence: 99%

Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

Pih

Kim

Gong

et al. 2019

J of Digest Diseases

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Objectives This study aimed to investigate the efficacy of prophylactic steroid administration in preventing post‐endoscopic submucosal dissection (ESD) esophageal stricture and to determine risk factors for these strictures. Methods Patients who underwent ESD for superficial esophageal neoplasms with a mucosal defect affecting >75% of the esophageal circumference between January 2011 and August 2016 were eligible. Patients were classified into three groups, including ESD‐alone group (n = 22), oral steroid group (n = 25) and intralesional steroid injection group (n = 6). Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors for esophageal stricture. Results The stricture rate was 50.0%, 20.0% and 33.3% in the ESD‐alone group, oral steroid group and steroid injection group, respectively. Patients treated with steroids had a significantly lower stricture rate than the ESD‐alone group (22.6% vs 50.0%, P = 0.046). Additionally, oral steroid group had a significantly lower stricture rate than the ESD‐alone group (P = 0.037). Multivariate analysis revealed that the extent of the circumferential mucosal defect was a significant risk factor for post‐ESD strictures (odds ratio [OR] 13.015, 95% confidence interval [CI] 2.257‐76.077, P = 0.004). The administration of steroids (OR 0.108, 95% CI 0.020‐0.578, P = 0.009), specifically oral steroids (OR 0.109, 95% CI 0.019‐0.622, P = 0.013), was associated with prevention of post‐ESD strictures. Conclusion Oral steroid prophylaxis appears to be a safe and effective treatment in preventing post‐ESD stricture and improving patients' quality of life.

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Section: Discussionmentioning

confidence: 99%

Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

Pih

Kim

Gong

et al. 2019

J of Digest Diseases

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“…23 Given its potential use in the treatment of neurodegenerative diseases and in other diseases commonly affecting elderly patients (e.g., cancer 18–21,32–44 ), the characterization of tranilast’s interaction with A β is important. The toxic effect of A β fibrils in AD patients is well documented.…”

Section: Discussionmentioning

confidence: 99%

Tranilast Binds to Aβ Monomers and Promotes Aβ Fibrillation

et al. 2013

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The antiallergy and potential anticancer drug tranilast has been patented for treating Alzheimer’s disease (AD), in which amyloid β-protein (Aβ) plays a key pathogenic role. We used solution NMR to determine that tranilast binds to Aβ40 monomers with ~300 μM affinity. Remarkably, tranilast increases Aβ40 fibrillation more than 20-fold in the thioflavin T assay at a 1:1 molar ratio, as well as significantly reducing the lag time. Tranilast likely promotes fibrillation by shifting Aβ monomer conformations to those capable of seed formation and fibril elongation. Molecular docking results qualitatively agree with NMR chemical shift perturbation, which together indicate that hydrophobic interactions are the major driving force of the Aβ–tranilast interaction. These data suggest that AD may be a potential complication for tranilast usage in elderly patients.

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“…[20][21][22] This may lead to greater reluctance in elderly patients and their relatives to grant consent for ESD interventions. In addition, although a significantly higher percentage of patients received anticoagulant drugs in group A than in group B, no elderly patients in either group developed delayed bleeding.…”

Section: Elderly Patients N=130mentioning

confidence: 99%

Efficacy and safety of endoscopic submucosal dissection for elderly patients with superficial squamous esophageal neoplasms

Peng

Shen

et al. 2016

UEG Journal

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Background: Little is known about the outcomes of endoscopic submucosal dissection in elderly patients with superficial squamous esophageal neoplasms. Objective: To assess the efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasms in elderly patients (!65 years) compared with non-elderly patients. Methods: All patients with superficial squamous esophageal neoplasms receiving endoscopic submucosal dissection were retrospectively analyzed. Among them, 130 were aged 65 or older (group A), and 201 were aged younger than 65 years (group B). Therapeutic efficacy, adverse events, and follow-up data were evaluated. Results: Group A had a higher prevalence of concomitant diseases than group B (52.3% vs. 14.9%, respectively). R0 resection rate was 82.3% in group A and 84.6 % in group B (P ¼ 0.717). The curative resection rate was 80.8% in group A and 83.6% in group B (P ¼ 0.653). The rate of procedure-related non-cardiopulmonary adverse events was 20.8% in group A and 16.9% in group B (P ¼ 0.377). The incidence of cardiopulmonary adverse events during or after the procedure was 6.2% in group A and 2.5% in group B (P ¼ 0.094). No procedure-related mortality was reported in either group. Conclusion: Endoscopic submucosal dissection is effective and safe for treating superficial squamous esophageal neoplasms in elderly patients.

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A Pilot Study of Scheduled Endoscopic Balloon Dilation With Oral Agent Tranilast to Improve the Efficacy of Stricture Dilation After Endoscopic Submucosal Dissection of the Esophagus

Abstract: We demonstrated for the first time that scheduled EBD combined with oral agent tranilast might be effective and safe for improving the efficacy of stricture dilation after esophageal ESD.

Cited by 38 publications

References 38 publications

Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm

Tranilast Binds to Aβ Monomers and Promotes Aβ Fibrillation

Efficacy and safety of endoscopic submucosal dissection for elderly patients with superficial squamous esophageal neoplasms

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