Managing esophageal strictures following endoscopic resection of superficial neoplastic lesions

Delgado, Alberto Álvarez; García, Maria Luis Pérez

doi:10.17235/reed.2021.8437/2021

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…Alberto Álvarez Delgado et al (3) discussed the management of esophageal strictures following endoscopic resection of superficial neoplastic lesions. In our case, the size of the lesion and the esophageal diverticulum may potentially increase the risk of esophageal strictures following endoscopic resection.…”

Section: Discussionmentioning

confidence: 99%

A superficial esophageal cancer with a diverticulum cured by endoscopic submucosal dissection

Zhang¹,

Ji²,

An³

et al. 2023

Rev Esp Enferm Dig

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Section: Discussionmentioning

confidence: 99%

A superficial esophageal cancer with a diverticulum cured by endoscopic submucosal dissection

Zhang¹,

Ji²,

An³

et al. 2023

Rev Esp Enferm Dig

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Prospects of polyglycolic acid sheets for the treatment of esophageal stricture after esophageal endoscopic submucosal dissection

Wang,

Shi

2024

World J Gastrointest Endosc

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Esophageal cancer is the seventh most common type of cancer and the sixth leading cause of cancer -related mortality worldwide. Endoscopic submucosal dissection (ESD) is widely used for the resection of early esophageal cancer. However, post-ESD esophageal stricture is a common long-term complication, which requires attention. Patients with post-ESD esophageal stricture often experience dysphagia and require multiple dilatations, which greatly affects their quality of life and increases healthcare costs. Therefore, to manage post-ESD esophageal stricture, researchers are actively exploring various strategies, such as pharmaceutical interventions, endoscopic balloon dilation, and esophageal stenting. Although steroids-based therapy has achieved some success, steroids can lead to complications such as osteoporosis and infection. Meanwhile, endoscopic balloon dilatation is effective in the short term, but is prone to recurrence and perforation. Additionally, esophageal stenting can alleviate the stricture, but is associated with discomfort during stenting and the complication of easy displacement also present challenges. Tissue engineering has evolved rapidly in recent years, and hydrogel materials have good biodegradability and biocompatibility. A novel type of polyglycolic acid (PGA) sheets has been found to be effective in preventing esophageal stricture after ESD, with the advantages of a simple operation and low complication rate. PGA membranes act as a biophysical barrier to cover the wound as well as facilitate the delivery of medications to promote wound repair and healing. However, there is still a lack of multicenter, large-sample randomized controlled clinical studies focused on the treatment of post-ESD esophageal strictures with PGA membrane, which will be a promising direction for future advancements in this field.

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Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application

Wang,

Ding,

Qian

et al. 2024

World J Gastrointest Endosc

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BACKGROUND Endoscopic submucosal dissection (ESD) is a reliable method to resect early esophageal cancer. Esophageal stricture is one of the major complications after ESD of the esophagus. Steroid prophylaxis for esophageal strictures, particularly local injection of triamcinolone acetonide (TA), is a relatively effective method to prevent esophageal strictures. However, even with steroid prophylaxis, stenosis still occurs in up to 45% of patients. Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients. AIM To identify the predictors of esophageal strictures after steroids application. METHODS Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion- and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study. The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis. RESULTS A total of 120 patients were included in the analysis. In the oral prednisone and oral prednisone combined with local tretinoin injection groups, the stenosis rates were 44/53 (83.0%) and 56/67 (83.6%), respectively. Among them, univariate analysis showed that the lesion circumference (P = 0.01) and submucosal injection solution (P = 0.04) showed significant correlation with the risk of stenosis formation. Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports, such as additional chemoradiotherapy and tumor location. We identified a lesion circumference < 5/6 (OR = 0.19; P = 0.02) and submucosal injection of sodium hyaluronate (OR = 0.15; P = 0.03) as independent predictors of on esophageal stricture formation. CONCLUSION Steroid prophylaxis effectively prevents stenosis. Moreover, the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures. Additional interventions should be considered in high-risk patients.

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Managing esophageal strictures following endoscopic resection of superficial neoplastic lesions

Cited by 3 publications

References 21 publications

A superficial esophageal cancer with a diverticulum cured by endoscopic submucosal dissection

A superficial esophageal cancer with a diverticulum cured by endoscopic submucosal dissection

Prospects of polyglycolic acid sheets for the treatment of esophageal stricture after esophageal endoscopic submucosal dissection

Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application

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