Department of Gastrointestinal Surgery, Graduate School of Medical and Dental Sciences (Medicine), Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Toshima Hospital, Tokyo, Japan.
Esophagus. 2021 Jul;18(3):594-603. doi: 10.1007/s10388-021-00818-0. Epub 2021 Mar 2.
Locoregional steroid injection prevents post-endoscopic submucosal dissection (ESD) esophageal stricture, but histological changes that occur following steroid injection in the human esophagus are unclear. This study investigated the histopathological characteristics caused by locoregional triamcinolone acetonide (TA) injection using human esophagectomy specimens.
From January 2014 to December 2019, among 297 patients (373 lesions) who underwent esophageal ESD, 13 patients who underwent additional esophagectomy after ESD were examined. Seven patients (TA group) with wide excisions were injected with TA after ESD and another six patients (Non-TA group) with smaller tumors were not injected with TA. The clinical background of these patients and histopathological features of ESD ulcer scar obtained from esophagectomy specimens were retrospectively investigated.
The circumferential rate of ESD excision was more than three-quarters in all cases in the TA group, whereas it was less than three-quarters in the Non-TA group. No other statistical difference in the clinical background was found between the two groups. The subepithelial fibrous tissue of the ESD ulcer scar in the TA group was significantly thinner than that in the Non-TA group (P < 0.05). There was no significant difference in the thickness of the regenerated epithelium and muscularis propria layer of the ESD ulcer scar.
Histological finding of thinning of the subepithelial fibrous tissue of ESD ulcer scar in the human esophagus after TA injection was obtained. This suggests that TA suppresses the proliferation of the fibrous tissue of the subepithelial layer to help prevent esophageal stricture after widespread ESD in the human esophagus.
局部类固醇注射可预防内镜黏膜下剥离术（ESD）后食管狭窄，但类固醇注射后在人体食管中发生的组织学变化尚不清楚。本研究使用人体食管切除术标本研究了局部曲安奈德（TA）注射引起的组织病理学特征。
从 2014 年 1 月至 2019 年 12 月，在 297 例（373 处病变）接受食管 ESD 的患者中，有 13 例患者在 ESD 后接受了额外的食管切除术。7 例（TA 组）广泛切除的患者在 ESD 后注射 TA，另 6 例（非 TA 组）肿瘤较小的患者未注射 TA。回顾性研究了这些患者的临床背景和从食管切除术标本中获得的 ESD 溃疡疤痕的组织病理学特征。
TA 组所有病例的 ESD 切除环周率均超过四分之三，而非 TA 组则不到四分之三。两组间临床背景无其他统计学差异。TA 组 ESD 溃疡疤痕的上皮下纤维组织明显比非 TA 组薄（P < 0.05）。ESD 溃疡疤痕的再生上皮和固有肌层的厚度无显著差异。
在 TA 注射后，在人体食管 ESD 溃疡疤痕中观察到上皮下纤维组织变薄的组织学发现。这表明 TA 抑制了上皮下纤维组织的增殖，有助于预防人体食管广泛 ESD 后发生食管狭窄。
