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三氯醋酸浸泡聚乙二醇酸片联合全覆膜金属支架治疗预防食管内镜黏膜下剥离术后狭窄的疗效。

Efficacy of triamcinolone-soaked polyglycolic acid sheet plus fully covered metal stent for preventing stricture formation after large esophageal endoscopic submucosal dissection.

机构信息

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

出版信息

Dis Esophagus. 2019 Feb 1;32(2). doi: 10.1093/dote/doy121.

Abstract

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.

摘要

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。

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