Hanaoka Noboru, Ishihara Ryu, Uedo Noriya, Takeuchi Yoji, Higashino Koji, Akasaka Tomofumi, Kanesaka Takashi, Matsuura Noriko, Yamasaki Yasushi, Hamada Kenta, Iishi Hiroyasu
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Endosc Int Open. 2016 Mar;4(3):E354-9. doi: 10.1055/s-0042-100903. Epub 2016 Feb 11.
Although steroid injection prevents stricture after esophageal endoscopic submucosal dissection (ESD), some patients require repeated sessions of endoscopic balloon dilation (EBD). We investigated the risk for refractory stricture despite the administration of steroid injections to prevent stricture in patients undergoing esophageal ESD. Refractory stricture was defined as the requirement for more than three sessions of EBD to resolve the stricture. In addition, the safety of steroid injections was assessed based on the rate of complications.
We analyzed data from 127 consecutive patients who underwent esophageal ESD and had mucosal defects with a circumferential extent greater than three-quarters of the esophagus. To prevent stricture, steroid injection was performed. EBD was performed whenever a patient had symptoms of dysphagia.
The percentage of patients with a tumor circumferential extent greater than 75 % was significantly higher in those with refractory stricture than in those without stricture (P = 0.001). Multivariate analysis adjusted for age, sex, history of radiation therapy, tumor location, and tumor diameter showed that a tumor circumferential extent greater than 75 % was an independent risk factor for refractory stricture (adjusted odds ratio [OR] 5.49 [95 %CI 1.91 - 15.84], P = 0.002). Major adverse events occurred in 3 patients (2.4 %): perforation during EBD in 2 patients and delayed perforation after EBD in 1 patient. The patient with delayed perforation underwent esophagectomy because of mediastinitis.
A tumor circumferential extent greater than 75 % is an independent risk factor for refractory stricture despite steroid injections. The development of more extensive interventions is warranted to prevent refractory stricture.
尽管类固醇注射可预防食管内镜黏膜下剥离术（ESD）后发生狭窄，但仍有部分患者需要多次接受内镜球囊扩张术（EBD）。我们调查了在接受食管ESD的患者中，尽管使用了类固醇注射来预防狭窄，但发生难治性狭窄的风险。难治性狭窄定义为需要进行超过三次EBD才能解除狭窄。此外，根据并发症发生率评估了类固醇注射的安全性。
我们分析了127例连续接受食管ESD且黏膜缺损周径大于食管四分之三的患者的数据。为预防狭窄，进行了类固醇注射。每当患者出现吞咽困难症状时，即进行EBD。
难治性狭窄患者中肿瘤周径大于75%的比例显著高于无狭窄患者（P = 0.001）。对年龄、性别、放疗史、肿瘤位置和肿瘤直径进行校正的多因素分析显示，肿瘤周径大于75%是难治性狭窄的独立危险因素（校正比值比[OR] 5.49 [95%CI 1.91 - 15.84]，P = 0.002）。3例患者（2.4%）发生了严重不良事件：2例患者在EBD期间发生穿孔，1例患者在EBD后发生迟发性穿孔。迟发性穿孔患者因纵隔炎接受了食管切除术。
尽管进行了类固醇注射，但肿瘤周径大于75%是难治性狭窄的独立危险因素。有必要开展更广泛的干预措施来预防难治性狭窄。
