Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Suntogun, Nagaizumi, Shizuoka, 411-8777, Japan.
Surg Endosc. 2018 Feb;32(2):751-759. doi: 10.1007/s00464-017-5732-5. Epub 2017 Jul 21.
Stenosis is a troublesome complication after wide endoscopic submucosal dissection (ESD). As steroids are known to prevent post-ESD esophageal stenosis, this study aimed to clarify the gastric effects.
This was a retrospective single-institution study. Between September 2002 and June 2015, 132 patients with a post-ESD mucosal defect exceeding three-fourths of the circumference were identified. Among them, 107 patients who did not undergo additional surgery for non-curative resection were reviewed. Steroid treatment (local injection and/or systemic) for stenosis prevention was administered to 28 patients within 10 days after ESD (steroid group). The incidence of stenosis and course of therapeutic endoscopic balloon dilation (EBD) were analyzed between the steroid and non-steroid group.
Stenosis occurred in 31% (33/107) of patients. Full circumferential defect and defect extending to the pyloric ring were significantly related with stenosis. The proportion of patients with a full circumferential defect was relatively higher in the steroid group (14%) compared to the non-steroid group (5%) (p = 0.111). There was no significant relationship between the incidence of stenosis and the use of steroids (steroid group 39%, non-steroid group 28%, p = 0.260). However, the interval from ESD to stenosis was significantly delayed among steroid-treated patients with a near-circumferential to three-fourth mucosal defect (p = 0.001) and among patients with ESD in the lower stomach (p = 0.002). The number of therapeutic EBDs and treatment duration did not differ significantly between the groups. Steroid treatment did not increase the incidence of ESD- and EBD-related complications.
Despite the retardation of the occurrence of stenosis in some subgroups, early steroid treatment did not a show a significant effect on stenosis prevention after wide gastric ESD. Further evaluation is needed to determine the dose and timing of steroid treatment for stenosis after wide gastric ESD.
狭窄是内镜黏膜下剥离术（ESD）后常见的并发症。由于类固醇可预防 ESD 后食管狭窄，本研究旨在阐明其对胃的影响。
这是一项回顾性单中心研究。2002 年 9 月至 2015 年 6 月，共发现 132 例 ESD 后黏膜缺损超过四分之三周长的患者。其中，对未因非治愈性切除而行额外手术的 107 例患者进行了回顾。对 ESD 后 10 天内接受预防性狭窄治疗的 28 例患者（类固醇组）行类固醇局部注射和/或全身治疗。分析了类固醇组和非类固醇组狭窄的发生率和治疗性内镜球囊扩张（EBD）的过程。
107 例患者中有 31%（33/107）发生狭窄。全周缺损和缺损延伸至幽门环与狭窄显著相关。类固醇组全周缺损的患者比例（14%）相对高于非类固醇组（5%）（p=0.111）。类固醇的使用与狭窄的发生率之间无显著关系（类固醇组 39%，非类固醇组 28%，p=0.260）。然而，对于接近全周至四分之三周黏膜缺损的类固醇治疗患者（p=0.001）和胃下部 ESD 患者（p=0.002），从 ESD 到狭窄的时间间隔明显延迟。两组之间的 EBD 治疗次数和治疗时间无显著差异。类固醇治疗并未增加 ESD 和 EBD 相关并发症的发生率。
尽管在某些亚组中延迟了狭窄的发生，但早期类固醇治疗对预防广泛胃 ESD 后狭窄并无显著效果。需要进一步评估广泛胃 ESD 后预防狭窄时类固醇的剂量和时机。
