Steroid injection and polyglycolic acid shielding to prevent stricture after esophageal endoscopic submucosal dissection: a retrospective comparative analysis (with video)

Sakaguchi, Yoshiki; Tsuji, Yosuke; Shinozaki, Tomohiro; Ohki, Daisuke; Mizutani, Hiroya; Minatsuki, Chihiro; Niimi, Keiko; Yamamichi, Nobutake; Koike, Kazuhiko

doi:10.1016/j.gie.2020.04.070

Cited by 26 publications

(42 citation statements)

References 23 publications

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“…Sakaguchi et al combined steroid injections and the shielding method with polyglycolic acid sheets which showed effectiveness in preventing post-ESD stricture. However, further studies are needed to evaluate whether polyglycolic acid (PGA) shielding has an additional effect on steroid injections [ 25 ], and a more effective and safe method to prevent stricture is still needed.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan

et al. 2021

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Background Endoscopic submucosal dissection (ESD) is gradually turning into the standard treatment for superficial esophageal squamous cell carcinoma (SESCC), however, the long-term outcomes have hardly ever been reported outside Japan. Method We consecutively recruited patients with SESCC who had received ESD treatment at E-Da Hospital. The demographics, pathological characteristics, and Lugol staining background pattern (type A or B: none or < 10 small Lugol-voiding lesions [LVLs]; type C or D: > 10 small or multiform LVLs) were collected, and then correlated to outcomes and survival. Results Total of 229 lesions were enrolled and the mean lesion size was 3.28 ± 1.69 (range 1–10) cm. 72% of the lesions had a type C-D Lugol staining background pattern. After ESD, the en bloc and R0 resection rates were 93.9% and 83.5%, respectively. Forty-nine subjects developed complications, including six (2.6%) with major bleeding, two (0.9%) with perforation, and 41 (17.9%) with strictures. Pathological staging showed that 19 cases had deep submucosal cancer invasion and subsequently received adjuvant therapies. During a mean follow-up period of 52.6 (range 3–146) months, 41 patients developed metachronous recurrence. The patients with a type C-D Lugol staining background pattern were associated with a higher risk of recurrence than those with few LVLs (log-rank P = 0.019). The 10-year survival rate was more than 90%, and only eight patients died of ESCC. Conclusion ESD has excellent long-term outcomes but a high risk of metachronous recurrence. The Lugol staining pattern over the background mucosa could offer the risk stratification of metachronous recurrence.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan

et al. 2021

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“…Previous studies of esophageal stents used 20-40 mg triamcinolone administered as one injection. [15][16][17]22,33 We therefore evaluated 15 mg, as well as 0.5-and 2-fold doses, to determine the optimal amount for the FCSEMS.…”

Section: Preparation Of Corticosteroid-eluting Stentsmentioning

confidence: 99%

“…14 Steroid injection or oral steroid medication can be used to prevent esophageal stricture after endoscopic dissection and BBS. [15][16][17][18][19][20] Therefore, an antibrotic agent, such as a corticosteroid, can be used to prevent restenosis of the biliary tract secondary to brosis.…”

Section: Introductionmentioning

confidence: 99%

Preclinical Evaluation of Endoscopic Placement of a Steroid-eluting Metal Stent in an In Vivo Porcine Benign Biliary Stricture Model

Jang

Fang

Nahm

et al. 2022

Preprint

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Treatment of benign biliary strictures (BBS) using fully covered self-expandable metal stents (FCSEMS) has a high success rate, but recurrence can occur. Corticosteroids may be useful based on their anti-fibrotic and anti-inflammatory effects. We investigated the safety and efficacy of corticosteroid-eluting FCSEMS in an animal model. BBSs were created by radiofrequency ablation in 12 mini-pigs. Four weeks later, FCSEMS coated with 0 mg (control), 15 mg (steroid 1x group), or 30 mg (steroid 2x group) triamcinolone were inserted endoscopically. The in vitro drug release assay revealed that the optimal stent had 15 mg of triamcinolone and a hydrophilic membrane. No transmural necrosis or perforation occurred in any animal. Fibrous wall thickness tended to decrease macroscopically and microscopically in a triamcinolone dose-dependent manner (control vs. steroid 2x group: 773.1 vs. 468.5 µm, P = 0.037). Thickness also decreased over time in the steroid 2x group (3 days vs. 4 weeks: 907.9 vs. 468.5 µm, P = 0.025). Blood parameters tended to improve after stent insertion. In a porcine BBS model, steroid-eluting FCSEMS showed potential as a safe and effective treatment modality to reduce fibrotic tissue. Studies are required to confirm their safety and efficacy in humans with refractory BBS.

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“…However, stricture formation after ESD has been reported in 90% of patients with mucosal defects covering >75% of the circumference 1,2 . Polyglycolic acid (PGA) sheet attachment is used to prevent strictures 3–5 . However, the attachment of the PGA sheet is sometimes difficult and time‐consuming because the attached sheet clings to the scope because of the narrow lumen and peristaltic movement.…”

Section: Brief Explanationmentioning

confidence: 99%

Easier attachment technique of polyglycolic acid sheet using thin‐endoscope for prevention of stricture after esophageal endoscopic submucosal dissection

Kono

Nagami

Fujiwara

2021

Digestive Endoscopy

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Steroid injection and polyglycolic acid shielding to prevent stricture after esophageal endoscopic submucosal dissection: a retrospective comparative analysis (with video)

Cited by 26 publications

References 23 publications

Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan

Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan

Preclinical Evaluation of Endoscopic Placement of a Steroid-eluting Metal Stent in an In Vivo Porcine Benign Biliary Stricture Model

Easier attachment technique of polyglycolic acid sheet using thin‐endoscope for prevention of stricture after esophageal endoscopic submucosal dissection

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