Background and Aims
Postoperative stricture after expansive esophageal endoscopic submucosal dissection
(ESD) is a severe adverse event. Previous single-arm reports have suggested that polyglycolic
acid (PGA) shielding may prevent stricture. This study was performed to assess the
efficacy of this method through a comparative analysis.
Methods
This is a retrospective analysis of 500 consecutive cases of esophageal ESD performed
between 2002 and 2018 at the University of Tokyo Hospital. After 2013, patients with
a diagnosis of superficial esophageal carcinoma covering more than half of the esophageal
circumference underwent preventive treatment with either PGA shielding or steroid
injection + PGA shielding after ESD. The efficacy of these methods for preventing
post-ESD stricture was assessed through multivariable logistic regression analysis.
Results
The risk of postoperative stricture was especially high in the cervical esophagus
(odds ratio [OR], 4.60; 95% confidence interval [CI], 0.65-61.09) and after total
circumferential resection (OR, 3.58×103; lower bound of 95% CI, >185). Steroid injection + PGA shielding was the only method
significantly effective in preventing stricture (OR, 0.30; 95% CI, 0.10-0.78; P = .009). In the relatively low-risk subgroup (excluding cervical esophageal cancer
and complete circumferential resection), the postoperative stricture rates for steroid
injection + PGA shielding versus PGA shielding versus control were 18.9% versus 41.4%
versus 51.7%, respectively (P = .015). However, the efficacy of this was limited in extremely high-risk cases.
Conclusion
The combination of steroid injection and PGA shielding is effective for preventing
post-ESD stricture. There is a need for even more effective methods for cervical esophageal
cancer and complete circumferential resection.
Graphical abstract
Graphical Abstract
Abbreviations:
CI (confidence interval), EBD (endoscopic balloon dilation), ESD (endoscopic submucosal dissection), OR (odds ratio), PGA (polyglycolic acid)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 03, 2020
Accepted:
April 18,
2020
Received:
January 20,
2020
Footnotes
If you would like to chat with an author of this article, you may contact Dr Tsuji at [email protected]
DISCLOSURE: Dr Tsuji has received research funding from Gunze Co. All other authors disclosed no financial relationships.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Stricture prevention after esophageal endoscopic submucosal dissectionGastrointestinal EndoscopyVol. 92Issue 6
- PreviewOver the past 2 decades, there has been a paradigm shift in the treatment of early esophageal cancer. Previously, esophagectomy was favored, but with advances in endoscopic technique, the morbidity and mortality of surgery could be avoided in most cases, and endoscopic resection rapidly became the preferred treatment modality. Initially, EMR allowed for en bloc resection of small tumors or piecemeal resection of larger lesions. Now, endoscopic submucosal dissection (ESD) allows for the en bloc resection of even very large superficial tumors.
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