1
|
Duan Y, Jia W, Liang Y, Zhang X, Yang Z, Yang Q. Progress in the treatment and prevention of esophageal stenosis after endoscopic submucosal dissection. Clin Res Hepatol Gastroenterol 2024; 48:102290. [PMID: 38311060 DOI: 10.1016/j.clinre.2024.102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
The primary treatment for early esophageal cancer and precancerous lesions is endoscopic submucosal dissection (ESD). However, this approach leads to a high incidence of postoperative esophageal stenosis, which can significantly impact a patient's quality of life. While various methods are available to prevent post-ESD esophageal stenosis, their effectiveness varies. Therefore, this study aims to provide an overview of the currently employed methods for preventing post-ESD esophageal stenosis in clinical practice in view of assisting clinical practitioners.
Collapse
Affiliation(s)
- Yangyang Duan
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Wenxiu Jia
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Ying Liang
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Xiuning Zhang
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Zhufeng Yang
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China.
| | - Qian Yang
- Department of Spleen and Stomach Diseases, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China; Hebei Key Laboratory of Turbidity Toxin Syndrome, Hebei, China; Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China.
| |
Collapse
|
2
|
Safarpour D, Jabbari B. Botulinum Toxin Treatment for Cancer-Related Disorders: A Systematic Review. Toxins (Basel) 2023; 15:689. [PMID: 38133193 PMCID: PMC10748363 DOI: 10.3390/toxins15120689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
This systematic review investigates the effect of botulinum neurotoxin (BoNT) therapy on cancer-related disorders. A major bulk of the literature is focused on BoNT's effect on pain at the site of surgery or radiation. All 13 published studies on this issue indicated reduction or cessation of pain at these sites after local injection of BoNTs. Twelve studies addressed the effect of BoNT injection into the pylorus (sphincter between the stomach and the first part of the gut) for the prevention of gastroparesis after local resection of esophageal cancer. In eight studies, BoNT injection was superior to no intervention; three studies found no difference between the two approaches. One study compared the result of intra-pyloric BoNT injection with preventive pyloromyotomy (resection of pyloric muscle fibers). Both approaches reduced gastroparesis, but the surgical approach had more serious side effects. BoNT injection was superior to saline injection in the prevention of esophageal stricture after surgery (34% versus 6%, respectively, p = 0.02) and produced better results (30% versus 40% stricture) compared to steroid (triamcinolone) injection close to the surgical region. All 12 reported studies on the effect of BoNT injection into the parotid region for the reduction in facial sweating during eating (gustatory hyperhidrosis) found that BoNT injections stopped or significantly reduced facial sweating that developed after parotid gland surgery. Six studies showed that BoNT injection into the parotid region prevented the development of or healed the fistulas that developed after parotid gland resection-parotidectomy gustatory hyperhidrosis (Frey syndrome), post-surgical parotid fistula, and sialocele. Eight studies suggested that BoNT injection into masseter muscle reduced or stopped severe jaw pain after the first bite (first bite syndrome) that may develop as a complication of parotidectomy.
Collapse
Affiliation(s)
- Delaram Safarpour
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| |
Collapse
|
3
|
Wang J, Li W, Yan Y, Yuan P, Cao C, Li S, Wu Q. Prevention of esophageal stricture after endoscopic submucosal dissection of squamous cell carcinoma using a 20-French nasogastric tube combined with oral steroid administration. Surg Endosc 2023; 37:8892-8900. [PMID: 37816996 DOI: 10.1007/s00464-023-10469-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/31/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Esophageal stricture is a major complication after esophageal endoscopic submucosal dissection (ESD) and when the mucosal defect exceeds 3/4 of the circumference. Various preventive methods have been reported to prevent stenosis. However, in the case of circumferential ESD, there is no way to prevent luminal stenosis effectively. This retrospective study aimed to evaluate the efficacy of 20-French nasogastric tubes (NGT) combined with oral steroids for the prevention of esophageal stricture after endoscopic submucosal dissection. METHODS Between January 2012 and December 2021, we enrolled 57 patients with post-ESD mucosal defects exceeding 3/4 of the esophageal circumference. Of them, the initial seven patients received oral steroid therapy and the subsequent 50 patients received 20-French NGT placements combined with oral steroid therapy. We retrospectively evaluated the rates of strictures and refractory strictures and explored risk factors for strictures with 20-French NGT. RESULTS The overall esophageal stricture rate was 42.1% (24/57). In the noncircumferential group, the esophageal stricture rate in patients with only oral steroid to prevent esophageal stricture was 85.7% (6/7), while the esophageal stricture rate was only 4.3% (1/23) in those with 20-French NGT placements and oral steroid. All 27 patients with whole-circumferential resection received 20-French NGT placements. The stricture rate was 63.0% (17/27), and the refractory stricture rate was 17.6% (3/27). CONCLUSION Using a 20-French NGT placement combined with oral steroid administration is an easy and safe alternative to prevent esophageal stricture after ESD, especially for patients with noncircumferential mucosal defects. Further studies are needed to develop an effective stricture prevention method for post-ESD whole-circumferential mucosal defects of the esophagus.
Collapse
Affiliation(s)
- Jing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Weifeng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yan Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Peng Yuan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Changqi Cao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Shijie Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China.
- First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832008, China.
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China.
| |
Collapse
|
4
|
Geng ZH, Zhu Y, Li QL, Fu PY, Xiang AY, Pan HT, Xu MD, Chen SY, Zhong YS, Zhang YQ, Ma LL, Hu JW, Cai MY, Qin WZ, Chen WF, Zhou PH. Muscular injury as an independent risk factor for esophageal stenosis after endoscopic submucosal dissection of esophageal squamous cell cancer. Gastrointest Endosc 2023; 98:534-542.e7. [PMID: 37207844 DOI: 10.1016/j.gie.2023.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND AIMS Stenosis after esophageal endoscopic submucosal dissection (ESD) has a high incidence, and muscular injury is an important risk factor for esophageal stenosis. Hence, this study aimed to classify muscular injury degrees and investigate their association with postoperative stenosis. METHODS This retrospective study included 1033 patients with esophageal mucosal lesions treated with ESD between August 2015 and March 2021. Demographic and clinical parameters were analyzed, and stenosis risk factors were identified using multivariate logistic regression. A novel muscular injury classification system was proposed and used to investigate the association between different muscular injury degrees and postoperative stenosis. Finally, a scoring system was established to predict muscular injury. RESULTS Of 1033 patients, 118 (11.4%) had esophageal stenosis. The multivariate analysis demonstrated that the history of endoscopic esophageal treatment, circumferential range, and muscular injury were significant risk factors for esophageal stenosis. Patients with type II muscular injuries tended to develop complex stenosis (n = 13 [36.1%], P < .05), and type II muscular injuries were more likely to predispose patients to severe stenosis than type I (73.3% and 92.3%, respectively). The scoring system showed that patients with high scores (3-6) were more likely to have muscular injury. The score model presented good discriminatory power in the internal validation (area under the receiver-operating characteristic curve, .706; 95% confidence interval, .645-.767) and goodness-of-fit in the Hosmer-Lemeshow test (P = .865). CONCLUSIONS Muscular injury was an independent risk factor for esophageal stenosis. The scoring system demonstrated good performance in predicting muscular injury during ESD.
Collapse
Affiliation(s)
- Zi-Han Geng
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Yan Zhu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Pei-Yao Fu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - An-Yi Xiang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Hai-Ting Pan
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Mei-Dong Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Shi-Yao Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Yun-Shi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Yi-Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Li-Li Ma
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Jian-Wei Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Wen-Zheng Qin
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Wei-Feng Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| |
Collapse
|
5
|
Libânio D, Pimentel-Nunes P, Bastiaansen B, Bisschops R, Bourke MJ, Deprez PH, Esposito G, Lemmers A, Leclercq P, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, Fuccio L, Bhandari P, Dinis-Ribeiro M. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023; 55:361-389. [PMID: 36882090 DOI: 10.1055/a-2031-0874] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.
Collapse
Affiliation(s)
- Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Pedro Pimentel-Nunes
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, FMUP, Porto, Portugal.,Gastroenterology, Unilabs, Portugal
| | - Barbara Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia.,Western Clinical School, University of Sydney, Sydney, Australia
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gianluca Esposito
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy. Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brueder Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.,University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| |
Collapse
|
6
|
Wang Y, Xia W, Tian L, Zhu B, Chen M, Si X, Lin S, Gong Y. Comparison of statins with steroids and botulinum toxin A in the prevention of benign strictures after esophageal endoscopic submucosal dissection: a retrospective cohort study. Surg Endosc 2023. [PMID: 36729230 DOI: 10.1007/s00464-023-09906-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Preventing benign strictures following esophageal endoscopic submucosal dissection (ESD) remains difficult, and finding a safe, effective, and simple management method is vital. We previously reported that rosuvastatin significantly reduced the incidence and severity of strictures in a rabbit model of esophageal stricture. Accordingly, in this study, we compared the effects of statins, steroids, and botulinum toxin A (BTX-A) on stricture prevention after ESD involving more than three-fourths of the luminal circumference. METHODS Of the 1019 ESD cases treated between January 2015 and December 2020, 246 met the inclusion criteria, with 21 cases excluded due to loss to follow-up, tumor recurrence, death, or need for additional surgery, radiotherapy, and/or chemotherapy. Of the 225 included cases, 145 received no intervention, while the remaining 80 were treated: 16 with oral steroids, 20 with topical triamcinolone acetonide (TA) injection, 21 with topical BTX-A injection, and 23 with statins. RESULTS The occurrence stricture rate in the statins group (17.4%, 4/23) was significantly lower than in the non-intervention (75.2%, 109/145, P = 0.000), oral steroids (56.3%, 9/16, P = 0.011) and TA injection (50%, 10/20, P = 0.023) groups, but comparable to in the BTX-A injection (38.1%, 8/21, P = 0.124) group. The dysphagia score was lower in the statin than non-intervention group (P = 0.000). Although there was no significant difference in the number of required dilations between groups, the maximum number of dilations in the statins group was only six. CONCLUSIONS Statins may be a potential treatment to prevent esophageal strictures after extensive ESD; however, clinical trials should be conducted to validate this.
Collapse
|
7
|
Yang X, Tan J, Liu Y, Feng Y, Shi R. Comparison of 180° anti-reflux mucosectomy versus 270° anti-reflux mucosectomy for treatment of refractory gastroesophageal reflux disease: a retrospective study. Surg Endosc 2021; 36:5002-5010. [PMID: 34782965 PMCID: PMC9160125 DOI: 10.1007/s00464-021-08857-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anti-reflux mucosectomy (ARMS) is a novel endoscopic treatment for refractory gastroesophageal reflux disease (rGERD). Several studies have validated its safety and effectiveness, but postoperative dysphagia remains in concern. Since the influence of different resection ranges on efficacy and complications of ARMS has rarely been studied, this study aimed to compare outcomes of 180°ARMS and 270°ARMS in treatment of rGERD. METHODS This study was conducted from August 2017 to September 2020. 39 eligible patients underwent either 180° ARMS or 270° ARMS and followed up at 6 months postoperation. Primary outcome measure was assessed by Gastroesophageal Reflux Disease Questionnaire (GERD-Q). Secondary outcomes included quality of life, PPI use, gastroesophageal flap valve grade, presence of reflux esophagitis, acid exposure time (AET), distal contractile integral (DCI), and integrated relaxation pressure (IRP) measured by high-resolution manometry (HRM) and complication rate. Per-protocol analysis was performed. RESULTS Among 39 patients, 18 underwent 180° ARMS, while 21 underwent 270° ARMS. At postoperative 6 months follow-up period, primary outcome showed no significant difference between two groups (p = 0.34). Similarly, no significant difference was demonstrated between groups regarding most secondary outcomes except for fewer complaints of newly dysphagia in 180° ARMS group. No other serious complications were observed in both groups. CONCLUSION Although 180° ARMS and 270° ARMS could be equally effective for treatment of rGERD, 180° ARMS might be more recommended due to lower incidence of newly post-procedural dysphagia.
Collapse
Affiliation(s)
- Xinyi Yang
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Dingjiaqiao street-87, Nanjing, 210009, Jiangsu, China
| | - Jiacheng Tan
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Dingjiaqiao street-87, Nanjing, 210009, Jiangsu, China
| | - Yang Liu
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Dingjiaqiao street-87, Nanjing, 210009, Jiangsu, China
| | - Yadong Feng
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Dingjiaqiao street-87, Nanjing, 210009, Jiangsu, China
| | - Ruihua Shi
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Dingjiaqiao street-87, Nanjing, 210009, Jiangsu, China.
| |
Collapse
|
8
|
Pérez-Cuadrado Robles E, Moreels TG, Piessevaux H, Yeung R, Aouattah T, Deprez PH. Risk factors of refractory post-endoscopic submucosal dissection esophageal strictures. Rev Esp Enferm Dig 2021; 113:813-819. [PMID: 34517715 DOI: 10.17235/reed.2021.8061/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION To comparatively assess the treatment outcomes of endoscopic dilatation in Barrett's neoplasia and squamous cell carcinoma (SCC) post- endoscopic submucosal dissection (ESD) strictures and to determine the risk or factors associated to refractory strictures Methods: Observational study. All consecutive patients presenting with a post-ESD stricture in 2007-2016 who underwent dilation therapy were included. Clinical, morphological and technical features were assessed to determine the risk factors of refractory strictures. RESULTS Of 414 consecutive patients treated by ESD, 83 (mean age: 65±10 years, 76% men) with 254 dilations (median: 3, range: 1-27) were considered. Barrett's neoplasia and SCC were the indications in 58 (69.9%) in 25 (30.1%) cases. Clinical success was achieved in 84.3% with a median of 3 sessions (range: 1-22). Circumferential resection in one-single procedure (13.2%) was associated to the need for a higher number of dilation sessions. By multivariable analysis, upper-esophageal location (OR: 11.479 [95%CI: 2.058-64.043], p=0.005), recurrent strictures (OR: 17.252 [95%CI: 2.833-105.069], p=0.002), and dilation-related complications (OR: 26.420 [95%CI: 1.736-401.966], p=0.018) were risk factors of refractory stenosis. CONCLUSION Preventive strategies, concomitant treatment, and careful dilatation protocols should be considered and undertaken in patients presenting with SCC located in the upper superior esophagus, intra-procedural perforation, and recurrent strictures.
Collapse
Affiliation(s)
| | - Tom G Moreels
- Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc
| | | | - Ralph Yeung
- Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc
| | - Tarik Aouattah
- Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc
| | - Pierre H Deprez
- Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc, Belgium
| |
Collapse
|
9
|
Zhou X, Chen H, Chen M, Ding C, Zhang G, Si X. Comparison of endoscopic injection of botulinum toxin and steroids immediately after endoscopic submucosal dissection to prevent esophageal stricture: a prospective cohort study. J Cancer 2021; 12:5789-5796. [PMID: 34475992 PMCID: PMC8408129 DOI: 10.7150/jca.60720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Widespread endoscopic submucosal dissection (ESD) in early esophageal cancer patients is closely associated with esophageal stricture, which dramatically reduces patients' quality of life and increases huge medical burdens. Endoscopic injection of steroid was proved as a protective method for post-ESD strictures. Other materials such as botulinum toxin type A (BTX-A) may be potential candidates. We conducted this prospective cohort study to compare the efficacy and feasibility of endoscopic injection of BTX-A and triamcinolone acetonide (TA) for the prevention of esophageal stricture. Methods: Seventy-eight patients with esophageal mucosal defects of more than two thirds of the circumference were successively enrolled and divided into 3 groups: BTX-A group (group A, n=26), TA group (group B, n=16) and control group (group C, n=36). Patients in group A were immediately injected with BTX-A after ESD, in group B were immediately injected with TA and in group C received ESD only. Endoscopy was performed when patients reported dysphagia symptoms and at 6 and 12 weeks post-ESD in patients without symptoms. Patients who experienced post-ESD esophageal strictures in all groups received bougie dilation. All patients were followed up for one year. Results: The proportion of patients developing stricture in BTX-A group was 30.00% (intention to treat analysis, 9/30) and 26.92% (per protocol analysis, 7/26), in TA group was 40.90% (intention to treat analysis, 9/22) and 43.75% (per protocol analysis, 7/16), and in control group was 84.21% (intention to treat analysis, 32/38) and 83.33% (per protocol analysis, 30/36) (p<0.001). When further comparing between each of the two groups, the incidence of esophageal stricture was lower in BTX-A group than that in control group (p<0.001), and lower in TA group than that in control group (p=0.004). Furthermore, in entire circumference mucosal defect subgroup, the esophageal stricture was significantly lower in BTX-A group than that in TA group (33.3% vs 100%, p=0.0454). Conclusions: Endoscopic injection of BTX-A and TA were effective in preventing post-ESD esophageal strictures and BTX-A injection was particularly effective in entire circumference mucosal defect patients. Multi-centered, randomized prospective study with larger sample size should be conducted. (Clinical trial registration number: ChiCTR2100042970, registered 1 February 2021, retrospectively registered, http://www.chictr.org.cn/listbycreater.aspx)
Collapse
Affiliation(s)
- Xiaoying Zhou
- Department of Gastroenterology, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Han Chen
- Department of Gastroenterology, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Meihong Chen
- Department of Gastroenterology, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chao Ding
- Department of Gastroenterology, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Guoxin Zhang
- Department of Gastroenterology, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinmin Si
- Department of Gastroenterology, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
10
|
Dressler D, Pan L, Su J, Teng F, Jin L. Lantox-The Chinese Botulinum Toxin Drug-Complete English Bibliography and Comprehensive Formalised Literature Review. Toxins (Basel) 2021; 13:370. [PMID: 34067301 PMCID: PMC8224638 DOI: 10.3390/toxins13060370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
In 1997, lanbotulinumtoxinA (LAN) was introduced in China. It is now available in Asia, Latin America and Eastern Europe under various brand names including Hengli®, Lantox®, Prosigne®, Lanzox®, Redux®, Liftox®, HBTX-A and CBTX-A. The literature on LAN is mostly published in Chinese language, restricting its international accessibility. We, therefore, wanted to generate a complete English bibliography of all LAN publications and then use it for a comprehensive formalised literature review. Altogether, 379 LAN publications (322 in Chinese and 57 in English) were retrieved from PubMed and Science and Technology Paper Citation Database. Indications covered are motor (257), glandular (16), pain (32) and aesthetics (48). Topics are neurological (250), aesthetic (48), paediatric (38), ophthalmological (18), urological (9), methodological (6), gastroenterological (5), ear, nose and throat (4) and surgical (1). Seventy-one publications are randomised controlled trials, forty-one publications are interventional studies and observational studies, fifteen publications are case studies, eighteen publications are reviews, and two publications are guidelines. LAN publications cover all relevant topics of BT therapy throughout a period of more than 20 years. This constitutes a publication basis resembling those of other BT drugs. None of the LAN publications presents data contradictory to those generated with other BT type-A drugs. LAN seems to have a similar efficacy and safety features when compared to onabotulinumtoxinA using a 1:1 LAN- onabotulinumtoxinA conversion ratio. Large controlled multicentre studies will become necessary for LAN's registrations in Europe and North America.
Collapse
Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Lizhen Pan
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China; (J.S.); (F.T.); (L.J.)
- Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China
| | - Junhui Su
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China; (J.S.); (F.T.); (L.J.)
- Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China
| | - Fei Teng
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China; (J.S.); (F.T.); (L.J.)
- Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China
| | - Lingjing Jin
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China; (J.S.); (F.T.); (L.J.)
- Department of Neurorehabilitation, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji Univeirsity School of Medicine, No. 2209 Guangxing Rd, Shanghai 201619, China
| |
Collapse
|
11
|
Hikichi T, Nakamura J, Takasumi M, Hashimoto M, Kato T, Kobashi R, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Okubo Y, Kobayakawa M, Ohira H. Prevention of Stricture after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer: A Review of the Literature. J Clin Med 2020; 10:jcm10010020. [PMID: 33374780 PMCID: PMC7796365 DOI: 10.3390/jcm10010020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/14/2022] Open
Abstract
Endoscopic resection has been the standard treatment for intramucosal esophageal cancers (ECs) because of the low risk of lymph node metastases in the lesions. In recent years, endoscopic submucosal dissection (ESD), which can resect large ECs, has been performed. However, the risk of esophageal stricture after ESD is high when the mucosal defect caused by the treatment exceeds 3/4 of the circumference of the lumen. Despite the subsequent high risk of luminal stricture, ESD has been performed even in cases of circumferential EC. In such cases, it is necessary to take measures to prevent stricture. Therefore, in this review, we aimed to clarify the current status of stricture prevention methods after esophageal ESD based on previous literature. Although various prophylactic methods have been reported to have stricture-preventing effects, steroid injection therapy and oral steroid administration are mainstream. However, in cases of circumferential EC, both steroid injection therapy and oral steroid administration cannot effectively prevent luminal stricture. To solve this issue, clinical applications, such as tissue shielding methods with polyglycolic acid sheet, autologous oral mucosal epithelial sheet transplantation, and stent placement, have been developed. However, effective prophylaxis of post-ESD mucosal defects of the esophagus is still unclear. Therefore, further studies in this research field are needed.
Collapse
Affiliation(s)
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Correspondence:
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Ryoichiro Kobashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Yoshinori Okubo
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Medical Research Center, Fukushima Medical University, Fukushima-City 960-1295, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| |
Collapse
|
12
|
van de Ven SEM, Snijders MJ, Bruno MJ, Koch AD. Effectiveness of topical budesonide in preventing esophageal strictures after endoscopic resection of esophageal cancer. Endosc Int Open 2020; 8:E1795-E1803. [PMID: 33269312 PMCID: PMC7671763 DOI: 10.1055/a-1266-3423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background and study aims A disadvantage of endoscopic resection (ER) of early esophageal cancer (EC) is the high stricture rate after resection. A risk factor for stricture development is a mucosal defect after ER of ≥ 75 % of the esophageal circumference. Stricture rates up to 94 % have been reported in these patients. The aim of this study was to investigate the effectiveness of oral treatment with topical budesonide for stricture prevention after ER of early EC. Patients and methods We performed a retrospective analysis of a prospective cohort study of patients who received topical budesonide after ER of EC between March 2015 and April 2020. The primary endpoint was the esophageal stricture rate after ER. Stricture rates of our cohort were compared with stricture rates of control groups in the literature. Results In total, 42 patients were treated with ER and topical budesonide. A total of 18 of 42 patients (44.9 %) developed a stricture. The pooled stricture rate of control groups in the literature was 75.3 % (95 % CI 68.8 %-81.9 %). Control groups consisted of patients with esophageal squamous cell carcinoma with a mucosal defect after ER of ≥ 75 % of the esophageal circumference. Comparable patients of our cohort had a lower stricture rate (47.8 % vs. 75.3 %, P = 0.007). Conclusions Topical budesonide therapy after ER for EC seems to be a safe and effective method in preventing strictures. The stricture rate after budesonide treatment is lower compared to the stricture rate of patients who did not receive a preventive treatment after ER reported in the literature.
Collapse
Affiliation(s)
| | - Manon J.B.L. Snijders
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arjun Dave Koch
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
13
|
Zhang Y, Zhang B, Wang Y, Zhang J, Wu Y, Xiao T, Liao Y, Bao Y, Qiu H, Sun S, Guo J. Advances in the Prevention and Treatment of Esophageal Stricture after Endoscopic Submucosal Dissection of Early Esophageal Cancer. J Transl Int Med 2020; 8:135-145. [PMID: 33062589 PMCID: PMC7534493 DOI: 10.2478/jtim-2020-0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) has become the main treatment for early esophageal cancer. While treating the disease, ESD may also cause postoperative esophageal stricture, which is a global issue that needs resolution. Various methods have been applied to resolve the problem, such as mechanical dilatation, glucocorticoids, anti-scarring drugs, and regenerative medicine; however, no standard treatment regimen exists. This article describes and evaluates the strengths and limitations of new and promising potential strategies for the treatment and prevention of esophageal strictures.
Collapse
Affiliation(s)
- Yue Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Baozhen Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yidan Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jingjing Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yufan Wu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tingyue Xiao
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ye Liao
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yiwen Bao
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hongyu Qiu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jintao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| |
Collapse
|
14
|
Abstract
Endoscopic submucosal dissection (ESD) has been widely applied as a less invasive and more effective method for treating early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett's esophagus. However, post-ESD esophageal stricture often occurs if patients suffer circumferential mucosal defects of more than three-quarters of the circumference of the esophagus, which makes it difficult for patients to swallow and greatly reduces their quality of life. Moreover, there is currently no standard method to treat post-ESD esophageal stricture, even though it is extraordinarily important to prevent its formation. In recent years, several strategies to prevent esophageal stricture have emerged. These strategies can be classified into pharmacological, mechanical, tissue engineering, and other novel strategies, with each strategy having its own strengths and weaknesses. Although the pharmacological prophylaxis and mechanical strategies are relatively mature, they still have their drawbacks like high time-consumption, the occurrence of re-stricture, and significant side effects. Tissue engineering strategies and other novel strategies have shown promising preliminary results, but more clinical trials are needed. In this review, we discuss these strategies, with a particular focus on tissue engineering strategies and other novel strategies. It is hoped that this discussion will aid in finding more effective and safer strategies to prevent esophageal stricture.
Collapse
Affiliation(s)
- Meihong Yu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| |
Collapse
|
15
|
Yamamoto Y, Kikuchi D, Nagami Y, Nonaka K, Tsuji Y, Fujimoto A, Sanomura Y, Tanaka K, Abe S, Zhang S, De Lusong MA, Uedo N. Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts. Dig Endosc 2019; 31 Suppl 1:4-20. [PMID: 30994225 DOI: 10.1111/den.13388] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/03/2019] [Indexed: 12/15/2022]
Abstract
Prevention therapy is recommended for lesions >1/2 of the esophageal circumference. Locoregional steroid injection is recommended for lesions >1/2-3/4 of the esophageal circumference and oral steroids are recommended for lesions >1/2 of the subtotal circumference. For lesions of the entire circumference, oral steroid combined with injection steroid is considered. Endoscopic balloon dilatation (EBD) is the first choice of treatment for stricture after esophageal endoscopic submucosal dissection (ESD). Radical incision and cutting or self-expandable metallic stent can be considered for refractory stricture after EBD. In case of intraoperative perforation during esophageal ESD, endoscopic clip closure should be initially attempted. Surgery is considered for treatment of delayed perforation. Current standard practice for prevention of delayed bleeding after gastric ESD includes prophylactic coagulation of vessels on post-ESD ulcers and giving proton pump inhibitors. Chronic kidney disease stage 4 or 5, multiple antithrombotic drug use, anticoagulant use, and heparin bridging therapy are high-risk factors for delayed bleeding after gastric ESD. Intraoperative perforation during gastric ESD is initially managed by endoscopic clip closure. If endoscopic clip closure is difficult, other methods such as over-the-scope clip (OTSC), polyglycolic acid (PGA) sheet shielding etc. are attempted. Delayed perforation usually requires surgical intervention, but endoscopic closure by OTSC or PGA sheet may be considered. Resection of three-quarters of the circumference is a risk factor for stenosis after gastric ESD. Giving prophylactic local steroid injection and/or oral steroid is reported, but effectiveness has not been fully verified as has been done for esophageal stricture. The main management method for gastric stenosis is EBD but it may cause perforation.
Collapse
Affiliation(s)
- Yorimasa Yamamoto
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kouichi Nonaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ai Fujimoto
- Department of Gastroenterology and Hepatology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoji Sanomura
- Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kyosuke Tanaka
- Department of Endoscopic Medicine, Mie University Hospital, Tsu, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shuo Zhang
- Digestive Department, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Mark Anthony De Lusong
- Section of Gastroenterology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
16
|
Abstract
Stricture formation after esophageal endoscopic resection has a negative impact on patients' quality of life because it causes dysphagia and requires multiple endoscopic dilations. Various methods by which to prevent stricture have recently been developed and reported. Among these methods, local steroid injection is the most commonly used and is currently considered the standard method for noncircumferential resection. However, local steroid injection has a limited effect on circumferential resection. Thus, oral steroid administration is used for such cases because it may have a stronger effect than local injection. Steroid treatment, both by local injection and oral administration, is effective and low-cost; however, it may cause fragility of the esophageal wall, resulting in adverse events such as perforation during balloon dilatation. Many innovative approaches have been developed, such as tissue-shielding methods with polyglycolic acid, tissue engineering approaches with autologous oral mucosal epithelial cell sheet transplantation, and stent insertion. These methods may be promising, but they are limited by a scarcity of data. Further investigations are needed to confirm the efficacy of these methods.
Collapse
Affiliation(s)
- Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
17
|
Affiliation(s)
- Kulwinder S Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Mitnala Sasikala
- Institute of Basic Sciences and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India
| |
Collapse
|
18
|
Chu Y, Chen T, Li H, Zhou P, Zhang Y, Chen W, Zhong Y, Yao L, Xu M. Long-term efficacy and safety of intralesional steroid injection plus oral steroid administration in preventing stricture after endoscopic submucosal dissection for esophageal epithelial neoplasms. Surg Endosc 2018; 33:1244-1251. [PMID: 30171398 DOI: 10.1007/s00464-018-6404-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/20/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has been widely accepted as the treatment for early-stage esophageal epithelial neoplasms. However, stricture is a common complication after large-circumference ESD. This retrospective study is conducted to evaluate the efficacy and safety of intralesional steroid injection plus oral steroid administration in preventing esophageal stricture. METHODS 70 patients with a mucosal defect extending over more than two-thirds of the circumference after esophageal ESD for epithelial neoplasms were enrolled in this study. Those who received intralesional triamcinolone injection combined with oral prednisolone administration were assigned to the treatment group, while those who were treated without any prophylaxis of esophageal stricture were assigned to the control group. The primary observation result was the frequency of stricture. The secondary observation results were the number of endoscopic balloon dilation (EBD) sessions and rate of complications. RESULTS Compared with the control group, the frequency of stricture (14.7% 5/34 patients vs. 51.5% 19/36 patients) and number of EBD sessions (mean 0.2 vs. 3.3) were significantly lower in the treatment group. One patient suffered from perforation in the treatment group and recovered with conservative treatment. None steroid-related complications were found during a long-term follow-up. CONCLUSIONS Intralesional steroid injection plus oral steroid administration is safe and effective in preventing stricture following esophageal ESD for esophageal epithelial neoplasms with a mucosal defect extending no less than two-thirds of the circumference in a long-term follow-up.
Collapse
Affiliation(s)
- Yuan Chu
- Endoscopy Center, and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Tao Chen
- Endoscopy Center, and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Hongqi Li
- Endoscopy Center, and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Pinghong Zhou
- Endoscopy Center, and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Yiqun Zhang
- Endoscopy Center, and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Weifeng Chen
- Endoscopy Center, and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Yunshi Zhong
- Endoscopy Center, and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Liqing Yao
- Endoscopy Center, and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Meidong Xu
- Endoscopy Center, and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
| |
Collapse
|
19
|
Shi P, Ding X. Progress on the Prevention of Esophageal Stricture after Endoscopic Submucosal Dissection. Gastroenterol Res Pract 2018; 2018:1696849. [PMID: 29686699 DOI: 10.1155/2018/1696849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/28/2018] [Indexed: 12/13/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) has been widely accepted as an effective, minimally invasive treatment for superficial esophageal cancers. However, esophageal stricture often occurs in patients with large mucosal defects after ESD. In this review, we discuss various approaches recently researched to prevent esophageal strictures after ESD. These approaches can be classified as pharmacological treatments, esophageal stent treatments, and tissue engineering approaches. Most of the preventive approaches still have their limitations and require further research. With the improvement of current therapies, ESD can be more widely utilized as a minimally invasive treatment with minimal complications.
Collapse
|
20
|
Han Y, Guo J, Sun S, Wu W, Wang S, Ge N, Liu X, Wang G, Wang S. Acellular dermal matrix for esophageal stricture prevention after endoscopic submucosal dissection in a porcine model. Gastrointest Endosc 2017; 86:1160-1167. [PMID: 28396274 DOI: 10.1016/j.gie.2017.02.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is considered an effective treatment for early esophageal cancer and precancerous lesions. Esophageal stenosis is closely associated with quasi-circumferential ESD. We examined whether post-ESD esophageal stricture can be prevented by grafting an acellular dermal matrix (ADM) membrane. METHODS Fourteen Bama miniature pigs were randomly divided into an ADM group (n = 7) and a control group (n = 7). Semicircumferential ESD was performed at the distal esophagus in all animals, and in the ADM group an ADM patch graft was placed at the resection site and secured innovatively with metal clips. Animals in the control group underwent ESD only. Endoscopy was performed at 3 days, 1 week, 2 weeks, and 4 weeks post-ESD, and fluoroscopy was performed at 4 weeks for assessment of the degree of stenosis, after which the remodeled esophageal tissues were excised for histologic analysis. RESULTS No animals in the ADM group developed clinically significant esophageal stenosis, whereas 42.8% (3/7) in the control group did. The degree of stenosis was severe in the control group (39.8% vs 17.2%, respectively; P = .01). Animals in the ADM group had less feeding difficulty and lost less weight (-.9 kg vs -4.1 kg, respectively; P = .007). Histologically, complete mucosal epithelium, slight local inflammation, and organized collagenous fibers were observed in the ADM group. CONCLUSIONS ADM patch graft appears, after short-term observation, to be a potentially useful new treatment strategy for prevention of esophageal stricture after ESD. A metal clip fixation technique is effective for endoscopic graft attachment.
Collapse
Affiliation(s)
- Ye Han
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jintao Guo
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Siyu Sun
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weichao Wu
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Sheng Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Ge
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiang Liu
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guoxin Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shupeng Wang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
21
|
Abe S, Iyer PG, Oda I, Kanai N, Saito Y. Approaches for stricture prevention after esophageal endoscopic resection. Gastrointest Endosc 2017; 86:779-791. [PMID: 28713066 DOI: 10.1016/j.gie.2017.06.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic resection of extensive esophageal lesions has become more common as endoscopic resection techniques and equipment have developed. However, extensive esophageal endoscopic resections can cause postoperative esophageal strictures, which have a negative impact on the quality of life of patients. We aimed to review current treatments and innovative approaches to prevent esophageal strictures after widespread endoscopic resection of esophageal lesions. METHODS We performed a comprehensive literature search from 2000 to 2016 using predetermined search terms to identify relevant articles and summarized their results as a narrative review. RESULTS A total of 21 original articles and case series were identified. A circumferential mucosal defect involving more than three fourths of the esophageal luminal circumference was the primary risk factor for developing an esophageal stricture after endoscopic resection. Oral and injectable steroid therapy demonstrated promise in preventing post-endoscopic submucosal dissection esophageal strictures, with both strategies significantly reducing the number of required endoscopic balloon dilations. More data are needed on prophylactic self-expandable metal stents, local botulinum toxin injection, and oral tranilast as a strategy to prevent post-endoscopic submucosal dissection esophageal strictures. Although preliminary studies of tissue-shielding resection sites with polyglycolic acid sheets and fibrin glue and autologous cell sheet transplantation have demonstrated promising results, additional larger validation studies are needed. CONCLUSIONS Oral and locally injected/administered steroids are first-line options for the prevention of esophageal strictures, but additional innovative solutions are being developed.
Collapse
Affiliation(s)
- Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Prasad G Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuo Kanai
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
22
|
Aoki S, Sakata Y, Shimoda R, Takezawa T, Oshikata-Miyazaki A, Kimura H, Yamamoto M, Iwakiri R, Fujimoto K, Toda S. High-density collagen patch prevents stricture after endoscopic circumferential submucosal dissection of the esophagus: a porcine model. Gastrointest Endosc 2017; 85:1076-85. [PMID: 27751874 DOI: 10.1016/j.gie.2016.10.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Extensive excision of the esophageal mucosa by endoscopic submucosal dissection (ESD) frequently evokes a luminal stricture. This study aimed to determine the efficacy of a high-density collagen patch for the prevention of esophageal stricture in extensive ESD. METHODS Six pigs underwent circumferential esophageal ESD under general anesthesia. In 3 pigs, artificial ulcers were covered by 2 collagen patches. The other 3 pigs underwent circumferential ESD only. RESULTS The 2 collagen patches were settled onto the ulcer surface using a general endoscope and instruments. The collagen patch-treated group showed significantly better patency rates on both the oral and anal sides of the wound area compared with the control group at day 14. The mucosal re-epithelization ratio was significantly promoted, and the extent of mucosal inflammation and fibrosis was significantly decreased with the collagen patch treatment in the wound area. The frequency of cells positive α-smooth muscle actin was significantly reduced in the collagen patch-treated group compared with the control group. CONCLUSIONS We have established a high-density collagen device that can reduce the esophageal stricture associated with extensive ESD. This easy-to-handle device would be useful during superficial esophageal cancer treatment by ESD.
Collapse
|
23
|
Affiliation(s)
- Horst Neuhaus
- Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| |
Collapse
|