Predictors of stricture after non-circumferential endoscopic submucosal dissection of the esophagus and single-dose triamcinolone injection immediately after the procedure - 14/07/23
, Noriko Matsuura, MD 2, Tomoya Ueda, MD 1, Yuki Okubo, MD 1, Yushi Kawakami, MD 1, Yasuhiro Tani, MD 1, Shunsuke Yoshii, MD, PhD 1, Satoki Shichijo, MD, PhD 1, Takashi Kanesaka, MD 1, Sachiko Yamamoto, MD 1, Yoji Takeuchi, MD, PhD 1, Koji Higashino, MD 1, Noriya Uedo, MD, PhD 1, Tomoki Michida, MD, PhD 1, Takashi Matsunaga, MD, PhD 3Abstract |
Background and Aims |
Local triamcinolone (TA) injection is widely used to prevent stricture formation after endoscopic submucosal dissection (ESD). However, stricture develops in up to 45% of patients despite this prophylactic measure. We therefore conducted a single-center prospective study to identify predictors of stricture after esophageal ESD and local TA injection.
Methods |
Patients who underwent esophageal ESD and local TA injection and who were comprehensively assessed for lesion- and ESD-related factors were included in the study. Multivariate analyses were conducted to identify the predictors of stricture.
Results |
A total of 203 patients were included in the analysis. Multivariate analysis identified residual mucosal width ≤5 mm (odds ratio [OR], 29.0; P < .0001) or 6 to 10 mm (OR, 3.7; P = .04), history of chemoradiotherapy (OR, 5.1; P = .045), and tumor in the cervical or upper thoracic esophagus (OR, 3.8; P = .018) as independent predictors of stricture. Based on the ORs of the predictors, patients were stratified into 2 groups according to stricture risk: patients in the high-risk group (residual mucosal width ≤5 mm or 6-10 mm with another predictor) had a stricture rate of 52.5% (31 of 59 cases), and patients in the low-risk group (residual mucosal width ≥11 mm or 6-10 mm without other predictors) had a stricture rate of 6.3% (9 of 144 cases).
Conclusions |
We identified predictors of stricture after ESD and local TA injection. Local TA injection prevented stricture formation after ESD in low-risk patients but was not sufficient to prevent stricture in high-risk patients. Additional interventions should thus be considered in high-risk patients. (University Hospital Medical Network Clinical Trials Registry number: UMIN 000028894.)
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : CI, CRT, ESD, ESU, IQR, OR, ROC, TA
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| DISCLOSURE: The following authors disclosed financial relationships: R. Ishihara: LecturefeesfromOlympus, FUJIFILM Medical, Daiichi Sankyo,AstraZeneca,EA Pharma, and Zeria Pharmaceutical. N. Uedo: Honoraria for lectures from Olympus Co Ltd, FUJIFILM Co Ltd, Boston Scientific Japan, Daiichi Sankyo, Takeda Pharmaceutical, EA Pharma, Otsuka Pharmaceutical Co Ltd, AstraZeneca, Miyarisan Pharmaceutical Co Ltd, 3D-Matrix Co Ltd, and AI Medical Co Ltd. Y. Takeuchi: LecturefeesfromOlympus,Boston Scientific(Japan), Daiichi Sankyo, Miyarisan Pharmaceutical Co Ltd, Asuka Pharmaceutical,AstraZeneca,EA Pharma, Zeria Pharmaceutical,FUJIFILM, Kaneka Medix, and Kyorin Pharmaceutical Co Ltd. T. Kanesaka: Honoraria for lectures from Olympus and AstraZeneca. S. Shichijo: Honoraria for lectures from EA Pharma, AstraZeneca, the AI Medical Service, and Janssen Pharmaceutical. All other authors disclosed no financial relationships. |
Vol 98 - N° 2
P. 170-177 - agosto 2023 Ritorno al numero
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