Gastroenterology, Hepatopancreatology and Digestive Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Brussels, Belgium.
Pathology Department, Hôpital Universitaire de Bruxelles (HUB) Jules Bordet Institute, Brussels, Belgium.
Endoscopy. 2024 Nov;56(11):811-819. doi: 10.1055/a-2328-6282. Epub 2024 May 16.
Extensive esophageal endoscopic submucosal dissections (ESDs) without preventive measures carry a high risk of stricture. Oral steroids and local injection of triamcinolone acetonide have proven to be effective in Asia for the prevention of esophageal stricture. This study aimed to assess the efficacy of a systematic steroid administration protocol for stricture prevention in a Western center.
A retrospective review was conducted of all esophageal ESDs performed at H.U.B. Erasme Hospital, Brussels between 2016 and 2022. Injection of triamcinolone was performed for mucosal defects between 50% and 89% of the circumference. We added oral corticosteroids for patients with resections of ≥90% of the circumference. The primary outcome was the incidence of symptomatic stenosis at 3 months. Secondary outcomes included the cumulative stricture rate assessed by endoscopy within 6 months of ESD. Potential risk factors of stricture were evaluated with univariate and multivariate analysis.
111 patients underwent 130 esophageal ESDs, with 59 patients receiving triamcinolone acetonide local injection and eight receiving local and oral corticosteroids. The primary outcome demonstrated a stricture incidence of 8.4%. The cumulative stricture rate assessed by endoscopy within 6 months of ESD was 10.4%. A mucosal defect of ≥60 mm in length was associated with a 15-fold increased risk of stricture, with circumferential extent also identified as being an independent prognostic factor for stricture.
Our protocol led to a low stricture rate, even after extensive resection. As a single session treatment without systemic side effects, triamcinolone injection could provide benefits as a preventive method after large esophageal resections.
广泛的食管内镜黏膜下剥离术（ESD）如果没有预防措施，会有很高的狭窄风险。在亚洲，口服类固醇和曲安奈德局部注射已被证明对预防食管狭窄有效。本研究旨在评估在西方中心系统应用类固醇预防方案预防狭窄的疗效。
回顾性分析了 2016 年至 2022 年期间在布鲁塞尔 H.U.B. Erasme 医院进行的所有食管 ESD。对于周长 50%至 89%的黏膜缺损，进行曲安奈德注射。对于周长切除≥90%的患者，我们加用口服皮质类固醇。主要结局是 3 个月时出现症状性狭窄的发生率。次要结局包括 ESD 后 6 个月内内镜评估的累积狭窄率。使用单因素和多因素分析评估狭窄的潜在危险因素。
111 例患者接受了 130 例食管 ESD，其中 59 例患者接受了曲安奈德局部注射，8 例患者接受了局部和口服皮质类固醇治疗。主要结局显示狭窄发生率为 8.4%。ESD 后 6 个月内内镜评估的累积狭窄率为 10.4%。黏膜缺损长度≥60mm 与狭窄风险增加 15 倍相关，周长也被确定为狭窄的独立预后因素。
即使在广泛切除后，我们的方案也导致狭窄率较低。作为一种单次治疗且无全身副作用的方法，曲安奈德注射可能作为大食管切除术后的一种预防方法提供益处。
