Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
Gastroenterology, Mayo Clinic Health System - Southwest Minnesota Region, Mankato, Minnesota, USA.
Gastrointest Endosc. 2021 Jun;93(6):1276-1282. doi: 10.1016/j.gie.2020.11.026. Epub 2020 Dec 9.
EMR and endoscopic submucosal dissection (ESD) are treatment modalities for Barrett's esophagus involving high-grade dysplasia or early cancer. Injectional corticosteroid therapy decreases the risk of procedure-related esophageal stricture (ES) formation. Our aim was to assess the efficacy of topical budesonide on the rate of ES formation after EMR or ESD.
Patients included prospectively from 3 tertiary endoscopy centers received 3 mg budesonide orally twice a day for 8 weeks after esophageal EMR or ESD of 50% or more of the esophageal circumference between January 1, 2014 and June 30, 2018. These patients were matched (1:3 ratio) retrospectively with a consecutive patient cohort who underwent EMR or ESD of 50% or more of the esophageal circumference without concomitant corticosteroid therapy. The primary endpoint was the presence of ES at the 12-week follow-up.
Twenty-five patients (budesonide) were matched with 75 patients (no budesonide). Most underwent EMR for Barrett's esophagus with biopsy-proven high-grade dysplasia or suspected T1a cancer. Although most baseline characteristics did not differ significantly, patients in the budesonide cohort tended to have a higher proportion of circumferential EMR. The proportion of patients with ES was not significantly lower in the budesonide cohort (16% vs 28%). On logistic regression analysis, budesonide remained associated with a lower incidence of ES (P = .023); however, when controlling for baseline characteristics with a propensity score weighted logistic regression model, there was no significant effect on ES formation (P = .176).
Topical budesonide might be associated with a reduction of ES after EMR or ESD; however, further studies are needed to verify our results.
EMR 和内镜黏膜下剥离术（ESD）是治疗 Barrett 食管高级别异型增生或早期癌的方法。注射皮质类固醇治疗可降低与治疗相关的食管狭窄（ES）形成的风险。我们的目的是评估 EMR 或 ESD 后局部布地奈德对 ES 形成率的影响。
前瞻性纳入 2014 年 1 月 1 日至 2018 年 6 月 30 日期间在 3 个三级内镜中心接受 EMR 或 ESD 治疗，ES 周长 50%或以上的患者。这些患者与同期接受 EMR 或 ESD 治疗，ES 周长 50%或以上但未同时接受皮质类固醇治疗的连续患者队列进行 1:3 比例的回顾性匹配。主要终点是 12 周随访时 ES 的存在。
25 例（布地奈德组）与 75 例（无布地奈德组）患者匹配。大多数患者因活检证实高级别异型增生或疑似 T1a 癌而接受 EMR 治疗。尽管大多数基线特征无显著差异，但布地奈德组患者的 EMR 周长比例较高。布地奈德组患者 ES 的比例无显著降低（16%比 28%）。Logistic 回归分析显示，布地奈德与 ES 的发生率降低相关（P=0.023）；然而，在倾向评分加权逻辑回归模型中控制基线特征后，ES 形成无显著影响（P=0.176）。
局部布地奈德可能与 EMR 或 ESD 后 ES 减少相关；然而，需要进一步研究来验证我们的结果。
