Original article
Clinical endoscopy
Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma

https://doi.org/10.1016/j.gie.2011.02.005Get rights and content

Background

Endoscopic submucosal dissection (ESD) permits en bloc removal of superficial esophageal squamous cell carcinoma. However, postprocedure stricture is common after ESD for extensive tumors, and multiple endoscopic balloon dilation (EBD) is required for recalcitrant cases.

Objective

To evaluate the effectiveness of oral prednisolone in controlling postprocedure esophageal stricture.

Design

Retrospective study.

Setting

Endoscopy department at a university hospital.

Patients

Patients who underwent complete circular or semicircular ESD for esophageal squamous cell carcinoma involving more than three fourths of the lumen were treated with either pre-emptive EBD or oral prednisolone.

Intervention

Preemptive EBD was started on the third day post-ESD and continued twice weekly for 8 weeks. Oral prednisolone was started at 30 mg/day on the third day post-ESD , tapered gradually, and then discontinued 8 weeks later. An additional EBD was performed on demand in both groups whenever dysphagia appeared.

Main Outcome Measurement

The incidence of esophageal stricture and number of EBD sessions required to relieve dysphagia.

Results

Stricture at 3 months after ESD was found in 7 of 22 patients in the preemptive EBD group but only 1 of 19 in the oral prednisolone group (P < .05). The average number of EBD sessions required was 15.6 in the preemptive EBD group and 1.7 in the oral prednisolone group (P < .0001). After complete circular ESD, 32.7 EBD sessions were needed on average in the preemptive EBD group, whereas fewer were needed in the oral prednisolone group (P < .05).

Limitations

Nonrandomized study.

Conclusions

Post-ESD esophageal strictures were persistent even if treated preemptively with multiple EBD sessions, but oral prednisolone may offer a useful preventive option.

Section snippets

Patients

Between October 2006 and February 2010, 154 superficial squamous cell neoplasms of the esophagus were treated with ESD in 95 patients at Nagasaki University Hospital. Of these, 43 consecutive patients with superficially extended SCC who underwent semicircular (more than three fourths but not complete circular) or complete circular ESD were enrolled. All of the esophageal tumors extended to involve more than three fourths of the circumference of the esophageal lumen. The location of tumors was

Results

There were 22 patients in the preemptive EBD group and 21 in the oral prednisolone group. However, 2 SCC patients in the oral prednisolone group who had a postoperative diagnosis of submucosal SCC with vessel involvement then underwent additional treatment (a total of 50 Gy of radiation therapy accompanied by chemotherapy consisting of 5-fluorouracil and nedaplatin) and were excluded from data analyses. Thus, the clinicopathological characteristics of the 41 eligible cases are summarized in

Discussion

Esophageal ESD remains associated with a substantial risk of complications.4, 5, 6, 7 Because patients with relatively large superficial esophageal epithelial neoplasms can be candidates for this procedure, postoperative stricture has arisen as a major concern with regard to clinical outcomes.7 Esophageal strictures can cause dysphagia or aspiration pneumonia and result in decreased quality of life.3 Once the patient begins to experience dysphagia from esophageal stricture, endoscopic dilation

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

    Drs Yamaguchi and Isomoto contributed equally to this article.

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