Tsujii Yoshiki, Hayashi Yoshito, Kawai Naoki, Yamada Takuya, Yamamoto Katsumi, Hayashi Shiro, Yoshii Shunsuke, Nagai Kengo, Inoue Takuya, Nishida Tsutomu, Iijima Hideki, Mita Eiji, Inoue Atsuo, Takehara Tetsuo
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Gastroenterology, Osaka General Medical Center, Osaka, Japan.
Endosc Int Open. 2017 Jul;5(7):E573-E579. doi: 10.1055/s-0043-110077. Epub 2017 Jun 23.
Endoscopic local steroid injection (LSI) has been used to prevent esophageal strictures after endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs). This study aimed to evaluate the safety and efficacy of LSI therapy.
From May 2007 to September 2014, at four institutions, 40 consecutive patients with SENs were treated with ESD that left a mucosal defect of more than three-quarters of the esophageal circumference. Two patients who underwent esophagectomy after ESD were excluded, and 38 patients were analyzed. The incidence of post-ESD strictures and adverse events associated with LSI were retrospectively investigated.
Prophylactic LSI was administered in 28 patients (LSI group), and not administered in 10 patients (Non-prevention group). Post-ESD stricture rates were significantly lower in the LSI group (43 %) than in the Non-prevention group (90 %) ( = 0.012). Endoscopic balloon dilation (EBD) was conducted in 11 patients (39 %) in the LSI group and in 7 (70 %) in the Non-prevention group. In the LSI group, perforation caused by EBD occurred in five patients, while in the Non-prevention group, it occurred in only one patient who had received subsequent LSI before the perforation. Four patients with perforation successfully recovered after conservative therapy, but the other two patients required surgical treatment. A review of follow-up examinations with endoscopic ultrasonography and narrow-band imaging showed impaired ulcer-healing process after LSI.
LSI is useful for preventing post-ESD strictures, but it appears to increase the risk of perforation in cases of EBD.
内镜下局部注射类固醇（LSI）已被用于预防内镜黏膜下剥离术（ESD）治疗浅表食管肿瘤（SENs）后发生食管狭窄。本研究旨在评估LSI治疗的安全性和有效性。
2007年5月至2014年9月期间，在四家机构，连续40例SENs患者接受了ESD治疗，术后食管黏膜缺损超过食管周长的四分之三。排除2例ESD术后接受食管切除术的患者，对38例患者进行分析。回顾性调查ESD术后狭窄的发生率以及与LSI相关的不良事件。
28例患者接受了预防性LSI（LSI组），10例患者未接受（非预防组）。LSI组ESD术后狭窄率（43%）显著低于非预防组（90%）（P = 0.012）。LSI组11例患者（39%）接受了内镜球囊扩张（EBD），非预防组7例患者（70%）接受了EBD。在LSI组，5例患者发生了由EBD引起的穿孔，而非预防组仅1例在穿孔前接受了后续LSI的患者发生了穿孔。4例穿孔患者经保守治疗成功康复，但另外2例患者需要手术治疗。对内窥镜超声和窄带成像的随访检查回顾显示，LSI后溃疡愈合过程受损。
LSI有助于预防ESD术后狭窄，但在EBD的情况下似乎会增加穿孔风险。
