A型肉毒毒素注射预防内镜黏膜下剥离术后食管狭窄。

Prevention of esophageal strictures after endoscopic submucosal dissection with the injection of botulinum toxin type A.

机构信息

Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China; Department of Gastroenterology and Hepatology, Chinese PLA 261 Hospital, Beijing, China.

Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.

出版信息

Gastrointest Endosc. 2016 Oct;84(4):606-13. doi: 10.1016/j.gie.2016.03.1484. Epub 2016 Mar 28.

DOI:10.1016/j.gie.2016.03.1484

PMID:27032884

Abstract

BACKGROUND AND AIMS

The use of endoscopic submucosal dissection (ESD) for management of widespread superficial esophageal squamous carcinoma is closely associated with esophageal stenosis. We investigated the efficacy and feasibility of endoscopic injection of botulinum toxin type A (BTX-A) for preventing esophageal strictures after ESD for superficial esophageal squamous carcinoma.

METHODS

Sixty-seven patients with superficial esophageal squamous cell carcinomas with mucosal defects that exceeded one half of the circumference of the esophagus after ESD treatment were enrolled and randomly divided into 2 groups (group A, n = 33; group B, n = 34). Patients in group A (BTX-A group) were immediately injected with BTX-A after ESD, whereas patients in group B (control group) received ESD only. Endoscopy was performed when patients reported dysphagia symptoms and at 12 weeks post-ESD in patients without symptoms. Patients who experienced post-ESD esophageal strictures in both groups received bougie dilation.

RESULTS

The number of patients who experienced esophageal strictures in group A (per protocol analysis, 6.1%, 2/33; intention to treat analysis, 11.4%, 4/35) was significantly less than that seen in group B (per protocol analysis, 32.4%, 11/34; intention to treat analysis, 37.8%, 14/37) (P < .05). Moreover, the number of bougie dilation procedures was significantly lower in group A (mean, 1.5; range, 0-2) than in group B (mean, 2.8; range, 0-5) (P < .05).

CONCLUSIONS

Endoscopic injection of BTX-A was effective in preventing post-ESD esophageal strictures and decreasing the times of bougie dilation procedures. (

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR-TRC-12003188.).

摘要

背景与目的

内镜黏膜下剥离术（ESD）广泛应用于治疗食管浅表性鳞状细胞癌，但术后易发生食管狭窄。本研究旨在探讨内镜下注射肉毒毒素 A（BTX-A）预防 ESD 术后食管狭窄的疗效和可行性。

方法

将 67 例 ESD 术后食管黏膜缺损超过食管半周的浅表性食管鳞状细胞癌患者随机分为 2 组（A 组，n=33；B 组，n=34）。A 组（BTX-A 组）患者 ESD 术后立即注射 BTX-A，B 组（对照组）仅行 ESD。有吞咽困难症状的患者进行内镜检查，无症状的患者在 ESD 后 12 周进行内镜检查。两组均发生 ESD 后食管狭窄的患者行探条扩张。

结果

A 组（按方案分析，6.1%，2/33；意向治疗分析，11.4%，4/35）和 B 组（按方案分析，32.4%，11/34；意向治疗分析，37.8%，14/37）发生食管狭窄的患者例数差异有统计学意义（P<.05）。A 组（平均 1.5 次，范围 0-2 次）探条扩张次数明显少于 B 组（平均 2.8 次，范围 0-5 次）（P<.05）。