Efficacy of Combination Therapy of Local Triamcinolone Injection and Oral Prednisolone Administration for Stricture Prevention After Extensive Non-Circumferential Esophageal Endoscopic Submucosal Dissection.

OBJECTIVES

Endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) has enabled en bloc resection of large lesions; however, post-ESD esophageal stricture remains an unresolved issue. Particularly, the standard steroid triamcinolone injection (LTI) therapy alone is insufficient for ≥ 7/8 circumferential mucosal defects (non-circumferential) after ESD. Thus, we aimed to compare the efficacy of LTI with a combination therapy of LTI and oral prednisolone administration (OPA).

METHODS

Between January 2010 and December 2020, we enrolled patients with post-ESD mucosal defects involving seven-eighths or more of the circumference of the esophagus but not circumferential, who had received LTI or a combination therapy of LTI and OPA as prophylactic treatment. Esophageal stricture was defined as a case where an ordinary-sized endoscope could not pass through the post-ESD site, thus requiring endoscopic balloon dilation (EBD) repeatedly until relief of the stricture was achieved. We retrospectively compared LTI and a combination of LTI and OPA in terms of stricture-free survival, stricture rate, and refractory stricture (requiring ≥ 6 EBD procedures) rate.

RESULTS

Overall, 42 and 26 patients in the LTI and combination group were enrolled. The stricture and refractory stricture rates were 42.9% and 16.7% in the LTI group and 26.9% and 15.4% in the combination group, respectively. The SFS rates at 12 weeks were 64.3% and 76.9% in the LTI group and the combination group, respectively.

CONCLUSIONS

This study suggested that the combination therapy of LTI and OPA for ≥ 7/8 circumferential mucosal defects (non-circumferential) post-ESD may be useful for preventing strictures.