Department of Endoscopy, Nagasaki University Hospital, Nagasaki, Japan.
Digestion. 2011;83(4):291-5. doi: 10.1159/000321093. Epub 2011 Feb 1.
A 74-year-old man with nausea underwent upper gastrointestinal endoscopy, and a 0-IIb type tumor was found in the middle thoracic esophagus. Histological examination with endoscopic biopsies revealed squamous cell carcinoma (SCC), and chromoendoscopy with iodine staining revealed that the superficial SCC involved nearly the entire circumference of the esophageal lumen. There were neither nodal nor distant metastases. Complete circular endoscopic submucosal dissection (ESD) was successfully achieved with tumor-free margins in an en bloc fashion. The histopathological examination confirmed a diagnosis of intramucosal invasive carcinoma limited to the lamina propria mucosae without angiolymphatic invasion. Oral prednisolone was started with 0.5 mg/kg daily on the 3rd post-ESD day, tapered gradually, and then discontinued 8 weeks later without adverse effects. There were no complaints of dysphagia following ESD. On follow-up endoscopy with iodine staining, which was scheduled at 1, 3 and 6 months after ESD, there was no postprocedural esophageal stricture, and neither recurrent nor metachronous lesions were found. Thus, the patient required no sessions of endoscopic balloon dilatation. At the last outpatient clinic visit 7 months after ESD, he remained well without dysphagia. Oral prednisolone administration may offer an effective therapeutic strategy to prevent the post-ESD esophageal stricture after complete circular ESD.
一位 74 岁男性因恶心接受了上消化道内镜检查，在食管中段发现了 0-IIb 型肿瘤。内镜活检的组织学检查显示为鳞状细胞癌（SCC），碘染色的 chromoendoscopy 显示浅表 SCC 几乎累及食管腔的整个圆周。无淋巴结或远处转移。成功地整块切除了无肿瘤边界的完整圆形内镜黏膜下剥离术（ESD）。组织病理学检查证实诊断为局限于黏膜固有层的黏膜内浸润性癌，无血管淋巴管侵犯。ESD 后第 3 天开始口服泼尼松龙，每天 0.5mg/kg，逐渐减量，8 周后停药，无不良反应。ESD 后无吞咽困难的主诉。ESD 后 1、3 和 6 个月行碘染色随访内镜检查，未见术后食管狭窄，无复发或同时性病变。因此，患者无需行内镜球囊扩张。ESD 后 7 个月的最后一次门诊就诊时，患者情况良好，无吞咽困难。口服泼尼松龙治疗可能是预防完全圆形 ESD 后食管狭窄的有效治疗策略。
