Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-higashi, Asahikawa, Hokkaido, 078-8510, Japan.
Department of Gastroenterology, Asahikawa City Hospital, Asahikawa, Japan.
Esophagus. 2019 Jul;16(3):258-263. doi: 10.1007/s10388-019-00659-y. Epub 2019 Mar 5.
Steroid therapy is primarily used to prevent esophageal stricture after endoscopic submucosal dissection (ESD). However, esophageal stricture can still occur after preventive therapy, and the effect of preventive steroid therapy cannot be predicted before stricture formation. This study aimed to clarify the risk factors for esophageal stricture after preventive steroid therapy.
This was a retrospective study conducted at three institutions. From January 2011 to February 2018, 28 large-sized SENs in 26 patients who had a mucosal defect that involved more than three-quarters of the esophageal circumference were enrolled. We classified white coats on artificial ulcers after esophageal ESD into three groups (thin, moderately thick, thick) based on endoscopic images obtained on postoperative day 7.
The white coat status on the artificial ulcer after ESD was a significant risk factor for post-ESD stricture (p < 0.05). The stricture rates in patients with thin, moderately thick and thick white coats were 10.0, 36.4 and 85.7%, respectively. When thin and moderately thick white coats were combined, the stricture rate was 23.8%. The rate of stricture in lesions with thick white coats was significantly higher than that in patients with thin white coats or thin to moderately thick white coats (p < 0.05). The multivariate analysis revealed that the white coat status was an independent factor related to esophageal stricture (odds ratio 13.70, 95% confidence interval 1.22-154.0; p = 0.034).
The thickness of the white coat is a useful marker for predicting the risk of post-ESD stricture and the effectiveness of preventive steroid therapy.
类固醇治疗主要用于预防内镜黏膜下剥离（ESD）后食管狭窄。然而，预防治疗后仍可能发生食管狭窄，且在狭窄形成前无法预测预防类固醇治疗的效果。本研究旨在明确预防类固醇治疗后发生食管狭窄的危险因素。
这是在三家机构进行的回顾性研究。2011 年 1 月至 2018 年 2 月，纳入了 26 例患者的 28 个大黏膜下肿瘤（SENs），这些患者的黏膜缺损涉及食管圆周的四分之三以上。我们根据术后第 7 天获得的内镜图像，将 ESD 后的人工溃疡上的白苔分为三组（薄、中厚、厚）。
ESD 后人工溃疡上的白苔状态是 ESD 后狭窄的显著危险因素（p<0.05）。薄、中厚和厚白苔患者的狭窄率分别为 10.0%、36.4%和 85.7%。当薄和中厚白苔合并时，狭窄率为 23.8%。厚白苔病变的狭窄率明显高于薄白苔或薄至中厚白苔患者（p<0.05）。多因素分析显示，白苔状态是与食管狭窄相关的独立因素（比值比 13.70，95%置信区间 1.22-154.0；p=0.034）。
白苔的厚度是预测 ESD 后狭窄风险和预防类固醇治疗效果的有用标志物。
