Strategies to prevent stricture after esophageal endoscopic submucosal dissection

Abstract

Endoscopic submucosal dissection (ESD) has been widely applied as a less invasive and more effective method for treating early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett's esophagus. However, post-ESD esophageal stricture often occurs if patients suffer circumferential mucosal defects of more than three-quarters of the circumference of the esophagus, which makes it difficult for patients to swallow and greatly reduces their quality of life. Moreover, there is currently no standard method to treat post-ESD esophageal stricture, even though it is extraordinarily important to prevent its formation. In recent years, several strategies to prevent esophageal stricture have emerged. These strategies can be classified into pharmacological, mechanical, tissue engineering, and other novel strategies, with each strategy having its own strengths and weaknesses. Although the pharmacological prophylaxis and mechanical strategies are relatively mature, they still have their drawbacks like high time-consumption, the occurrence of re-stricture, and significant side effects. Tissue engineering strategies and other novel strategies have shown promising preliminary results, but more clinical trials are needed. In this review, we discuss these strategies, with a particular focus on tissue engineering strategies and other novel strategies. It is hoped that this discussion will aid in finding more effective and safer strategies to prevent esophageal stricture.

Histological changes in the human esophagus following triamcinolone injection to prevent esophageal stricture after endoscopic submucosal dissection

“…These histological findings suggest that locoregional TA injection suppresses the proliferation of the SF and may contribute to the prevention of esophageal strictures after widespread ESD. Previous studies have reported methods, such as preventive balloon dilatation, steroid administration, esophageal stent treatment, and tissue engineering, to prevent post-ESD esophageal stricture [11,[17][18][19][20][21][22]. Among these methods, steroid administration to prevent stricture included oral steroid administration, TA injection, and TA-filling method.…”

“…Previous studies have reported methods, such as preventive balloon dilatation, steroid administration, esophageal stent treatment, and tissue engineering, to prevent post-ESD esophageal stricture [ 11 , 17 – 22 ]. Among these methods, steroid administration to prevent stricture included oral steroid administration, TA injection, and TA-filling method.…”

Esophageal regenerative therapy using cell sheet technology

“…Yu et al. [ 45 ] classified strategies to prevent esophageal stricture after ESD into five categories: (1) Pharmacological prophylaxis, (2) Mechanical strategies, (3) Tissue engineering strategies, (4) Autologous transplantation, and (5) Other novel strategies. Cell sheets transplantation and extracellular matrix approaches are included in the Tissue engineering strategies.…”

Topical oro-dispersible budesonide tablets for stricture prevention after near circumferential ESD for esophageal squamous cell cancer – a case report

“…Endoscopic submucosal dissection (ESD) is the standard treatment for early esophageal cancer with minimal or absent risk of lymph node metastasis [1][2][3]. Unfortunately, resections comprising more than 70-80 % of the circumference are associated with a high risk (up to 100 %) of stricture formation [4,5]. To date, steroidseither applied by repetitive local injection [6,7] or as systemic high dose treatmentare most often used to prevent strictures [4,8,9].…”

“…Unfortunately, resections comprising more than 70-80 % of the circumference are associated with a high risk (up to 100 %) of stricture formation [4,5]. To date, steroidseither applied by repetitive local injection [6,7] or as systemic high dose treatmentare most often used to prevent strictures [4,8,9]. However, even the use of such preventive measures does not completely avoid strictures that require endoscopic treatment.…”