Ng Hoi-Ioi, Liu Yi, Liu Yong, Dou Li-Zhou, He Shun, Wang Gui-Qi
Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Endoscopic Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Updates Surg. 2025 Feb 13. doi: 10.1007/s13304-025-02069-5.
Refractory esophageal stenosis (RES) after endoscopic submucosal dissection (ESD) is challenging in clinical practice. This study aimed to evaluate endoscopic radial incision (ERI) combined with the local injection of triamcinolone acetonide for RES and to assess its safety and efficacy. A total of nine patients (five males; age range: 50-76 years) who underwent ERI + triamcinolone acetonide for RES after ESD between August 2019 and November 2022 were analyzed. The primary endpoint was the duration of treatment. The length of the stenosed portion, procedure time, sessions of endoscopic therapy, effectiveness rate, success rate, dysphagia grade, complications, and quality of scores were also analyzed. The effectiveness and success rates were 100% and 88.9%, respectively. The mean number of sessions of ERI + triamcinolone acetonide was 2.2 (1.0-4.0). The mean procedure time was 25.9 ± 3.8 min. No severe complications, including bleeding or perforation, were observed during the perioperative period. Dysphagia symptoms were relieved in all patients after endoscopic treatment. Patients had significantly better functional scales for social functioning and global health status and lower rates of fatigue, gastrointestinal symptoms, and financial difficulties after treatment. ERI + triamcinolone acetonide can be considered a safe and effective treatment for RES after ESD. Larger prospective clinical trials are needed to confirm its utility.
内镜黏膜下剥离术(ESD)后难治性食管狭窄(RES)在临床实践中具有挑战性。本研究旨在评估内镜下径向切口(ERI)联合曲安奈德局部注射治疗RES的安全性和有效性。分析了2019年8月至2022年11月期间9例接受ERI联合曲安奈德治疗ESD术后RES的患者(5例男性,年龄范围:50 - 76岁)。主要终点为治疗持续时间。还分析了狭窄部位长度、手术时间、内镜治疗次数、有效率、成功率、吞咽困难分级、并发症及评分质量。有效率和成功率分别为100%和88.9%。ERI联合曲安奈德的平均治疗次数为2.2次(1.0 - 4.0次)。平均手术时间为25.9±3.8分钟。围手术期未观察到严重并发症,包括出血或穿孔。内镜治疗后所有患者吞咽困难症状均得到缓解。治疗后患者的社会功能和整体健康状况功能量表显著改善,疲劳、胃肠道症状及经济困难发生率降低。ERI联合曲安奈德可被认为是ESD术后RES的一种安全有效的治疗方法。需要更大规模的前瞻性临床试验来证实其效用。