Endosc Int Open 2016; 04(09): E1017-E1022
DOI: 10.1055/s-0042-111906
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Hybrid therapy with locoregional steroid injection and polyglycolic acid sheets to prevent stricture after esophageal endoscopic submucosal dissection

Yasuaki Nagami
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Masatsugu Shiba
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Kazunari Tominaga
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Masaki Ominami
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Shusei Fukunaga
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Satoshi Sugimori
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Fumio Tanaka
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Noriko Kamata
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Tetsuya Tanigawa
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Hirokazu Yamagami
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Toshio Watanabe
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Yasuhiro Fujiwara
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Tetsuo Arakawa
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
› Author Affiliations
Further Information

Publication History

submitted23 March 2016

accepted after revision13 June 2016

Publication Date:
25 August 2016 (online)

Background and study aim: The incidence of stricture formation caused by endoscopic submucosal dissection (ESD) for widespread lesions is high, and stricture formation can reduce quality of life. We evaluated the prophylactic efficacy of hybrid therapy using a locoregional steroid injection and polyglycolic acid (PGA) sheets with fibrin glue to prevent stricture formation after esophageal ESD in high risk patients in whom we predicted stricture formation would be difficult to prevent with a single prophylactic steroid injection.

Methods: Ten patients who underwent esophageal ESD were enrolled (entire-circumference: n = 6; sub-circumference, more than 5/6 of the circumference: n = 4). A single locoregional steroid injection and PGA sheets with fibrin glue were used after ESD. We evaluated the incidence of stricture formation, the number of endoscopic balloon dilation (EBD) procedures needed to treat the stricture formation, and adverse events of the therapy.

Results: Esophageal stricture formation occurred in 50.0 % of patients (5/10) (median EBD sessions 0.5, range 0 – 16). Subanalysis showed that stricture formation occurred in 37.5 % of patients (3/8) excluded the lesions located near a previous scar from ESD or surgical anastomosis site (median EBD sessions 0, range 0 – 4).

Conclusion: Hybrid therapy using a locoregional steroid injection and PGA sheets with fibrin glue may have the potential to prevent esophageal stricture formation after esophageal ESD in high risk patients.

 
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