The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection

Abstract

Background: Use of endoscopic submucosal dissection (ESD) for management of widespread superficial esophageal carcinomas may be complicated by the development of severe strictures, which may require serial treatment with endoscopic balloon dilatation (EBD).

Objective: The goal of this study was to determine the efficacy of endoscopic triamcinolone injection (ETI) for the prevention of stricture formation after ESD.

Design: Case series.

Setting: Tertiary-care referral center.

Patients: A total of 41 consecutive patients who had a semi-circumferential mucosal defect that arose after ESD for superficial esophageal squamous cell carcinomas were enrolled in this study.

Interventions: EBD and ETI.

Main outcome measurements: Incidence of stricture and frequency of required EBD.

Results: ETI was performed in one group of patients (study group, n = 21) but not in the other (control group, n = 20). The incidence of stricture was significantly lower in the study group (19.0%) than in the control group (75.0%; P < .001). The number of required EBDs was also lower in the study group (mean, 1.7; range, 0-15) than in the control group (mean, 6.6; range 0-20). There were no side effects or complications associated with ETI.

Limitations: Nonrandomized study design and small number of patients in a single endoscopic center.

Conclusions: This study suggests that ETI is safe and effective for the prevention of esophageal stricture in patients undergoing ESD for superficial esophageal squamous cell carcinomas.