Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China.
Dis Esophagus. 2019 Feb 1;32(2). doi: 10.1093/dote/doy121.
Esophageal stricture is a major problem for patients with large superficial esophageal squamous cell neoplasms (SESCNs) after endoscopic submucosal dissection (ESD). Although many measures could be used as prophylaxis for post-ESD strictures, a well-accepted method has not yet been established. We propose using a triamcinolone-soaked polyglycolic acid sheet plus fully covered metal stent (TS-PGA+FCMS) as a novel method to prevent stricture formation after large esophageal ESD. From June 2016 to May 2017, nine patients with SESCNs (≥3/4 of the esophageal circumference) who underwent TS-PGA+FCMS placement immediately after ESD and did not require additional surgical resection were enrolled in this case series. All stents were removed 4-6 weeks post-ESD. The sizes of mucosal defects in 9 patients were 3/4 (n = 1), 4/5 (n = 2), 1/1 (n = 6). The average size of resection was 90.0 mm (range: 60-140 mm). The incidence of stricture was 33.3% (3/9) of patients. No stricture occurred in 3 patients with noncircumferential resection, while stricture occurred in 50% (3/6) patients with circumferential resection. The median number of EBD sessions was 4 (range: 3-4 sessions). No adverse events or recurrences were observed during the median follow-up period of 15.2 months (range: 12-22 months). The TS-PGA+FCMS method is safe and may decrease the incidence of esophageal stricture and the number of EBD sessions after large esophageal ESD.
食管狭窄是内镜黏膜下剥离术(ESD)后大表浅食管鳞癌(SESCN)患者的主要问题。尽管有许多措施可用于预防 ESD 后狭窄,但尚未建立一种公认的方法。我们提出使用曲安奈德浸泡的聚乙醇酸片加全覆膜金属支架(TS-PGA+FCMS)作为预防大食管 ESD 后狭窄形成的新方法。2016 年 6 月至 2017 年 5 月,我们对 9 例 SESCN 患者(≥食管周长的 3/4)行 ESD 后立即放置 TS-PGA+FCMS 治疗,且这些患者均无需额外的手术切除。所有支架在 ESD 后 4-6 周取出。9 例患者的黏膜缺损大小为 3/4(n=1)、4/5(n=2)、1/1(n=6)。平均切除面积为 90.0mm(范围:60-140mm)。9 例患者中,狭窄发生率为 33.3%(3/9)。非环周切除的 3 例患者中无狭窄发生,而环周切除的 6 例患者中有 50%(3/6)发生狭窄。平均行内镜下食管扩张术(EBD)次数为 4 次(范围:3-4 次)。中位随访 15.2 个月(范围:12-22 个月)期间,未观察到不良事件或复发。TS-PGA+FCMS 方法安全,可降低大食管 ESD 后食管狭窄的发生率和 EBD 次数。