High-dose dexamethasone may prevent esophageal stricture after endoscopic submucosal dissection

Abstract

We report a rare case of esophageal endoscopic submucosal dissection (ESD) in a patient who underwent high-dose dexamethasone therapy for multiple myeloma shortly after ESD. A 61-year-old male was referred for treatment of esophageal superficial squamous cell carcinoma and underwent curative ESD. During his hospitalization for ESD, further examination for worsening back pain and gait disorder revealed multiple myeloma with multiple bone metastases. Consequently, high-dose dexamethasone therapy (40 mg × 4 days × 3 courses) was started on the 9th day after ESD. He was successfully treated by the subsequent peripheral blood stem cell transplantation. In the follow-up endoscopies, the artificial ulcer was shown to have re-epithelialized gradually with little or no size reduction of the ulcer bed. Minimal deformation of the lumen was observed. Histopathological assessment after surgical resection at a later date revealed thinned submucosa with minimal fibrosis of the ESD scar. This case demonstrated the effect of dexamethasone on the healing process of the artificial ulcer. Dexamethasone can be potentially useful for prevention of postoperative stricture, which is a major complication of esophageal ESD.

Keywords: ESD; Esophagus; Steroid; Stricture.