Hikichi Takuto, Nakamura Jun, Takasumi Mika, Hashimoto Minami, Kato Tsunetaka, Kobashi Ryoichiro, Takagi Tadayuki, Suzuki Rei, Sugimoto Mitsuru, Sato Yuki, Irie Hiroki, Okubo Yoshinori, Kobayakawa Masao, Ohira Hiromasa
Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan.
Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan.
J Clin Med. 2020 Dec 23;10(1):20. doi: 10.3390/jcm10010020.
Endoscopic resection has been the standard treatment for intramucosal esophageal cancers (ECs) because of the low risk of lymph node metastases in the lesions. In recent years, endoscopic submucosal dissection (ESD), which can resect large ECs, has been performed. However, the risk of esophageal stricture after ESD is high when the mucosal defect caused by the treatment exceeds 3/4 of the circumference of the lumen. Despite the subsequent high risk of luminal stricture, ESD has been performed even in cases of circumferential EC. In such cases, it is necessary to take measures to prevent stricture. Therefore, in this review, we aimed to clarify the current status of stricture prevention methods after esophageal ESD based on previous literature. Although various prophylactic methods have been reported to have stricture-preventing effects, steroid injection therapy and oral steroid administration are mainstream. However, in cases of circumferential EC, both steroid injection therapy and oral steroid administration cannot effectively prevent luminal stricture. To solve this issue, clinical applications, such as tissue shielding methods with polyglycolic acid sheet, autologous oral mucosal epithelial sheet transplantation, and stent placement, have been developed. However, effective prophylaxis of post-ESD mucosal defects of the esophagus is still unclear. Therefore, further studies in this research field are needed.
内镜切除术一直是黏膜内食管癌(EC)的标准治疗方法,因为病变发生淋巴结转移的风险较低。近年来,已经开展了能够切除较大EC的内镜黏膜下剥离术(ESD)。然而,当治疗引起的黏膜缺损超过管腔周长的3/4时,ESD术后食管狭窄的风险很高。尽管随后发生管腔狭窄的风险很高,但即使是环形EC病例也进行了ESD。在这种情况下,有必要采取措施预防狭窄。因此,在本综述中,我们旨在根据既往文献阐明食管ESD术后预防狭窄方法的现状。尽管已经报道了各种预防方法具有预防狭窄的作用,但类固醇注射疗法和口服类固醇是主流方法。然而,在环形EC病例中,类固醇注射疗法和口服类固醇都不能有效预防管腔狭窄。为了解决这个问题,已经开发了一些临床应用方法,如使用聚乙醇酸片的组织屏蔽方法、自体口腔黏膜上皮片移植和支架置入。然而,ESD术后食管黏膜缺损的有效预防仍不明确。因此,该研究领域需要进一步的研究。