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Liu S, Chai N, Lin Y, Wang N, Li L, Zhang N, Linghu E. Autologous skin-grafting surgery with novel continuous liquid infusion stent for prevention of esophageal stenosis after complete circular endoscopic submucosal tunnel dissection. Endoscopy 2024; 56:E290-E291. [PMID: 38575117 PMCID: PMC10994691 DOI: 10.1055/a-2268-5590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- Shengzhen Liu
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ningli Chai
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yunjuan Lin
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nanjun Wang
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Longsong Li
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nan Zhang
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Enqiang Linghu
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Lai H, Yip HC, Gong Y, Chan KF, Leung KKC, Chan MS, Xia X, Chiu PWY. MFGE8 in exosomes derived from mesenchymal stem cells prevents esophageal stricture after endoscopic submucosal dissection in pigs. J Nanobiotechnology 2024; 22:143. [PMID: 38561800 PMCID: PMC10986023 DOI: 10.1186/s12951-024-02429-0] [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: 12/24/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is the current standard treatment for early-stage esophageal neoplasms. However, the postoperative esophageal stricture after extensive mucosal dissection remains a severe challenge with limited effective treatments available. In this study, we introduced a chitosan/gelatin (ChGel) sponge encapsulating the adipose mesenchymal stem cells (ADMSCs)-derived exosomes (ChGelMSC-Exo) for the prevention of esophageal stenosis after ESD in a porcine model. RESULTS Pigs were randomly assigned into (1) ChGelMSC-Exo treatment group, (2) ChGelPBS group, and (3) the controls. Exosome treatments were applied immediately on the day after ESD as well as on day 7. Exosome components crucial for wound healing were investigated by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and small RNA sequencing. ChGelMSC-Exo treatment significantly reduced mucosal contraction on day 21, with less fiber accumulation and inflammatory infiltration, and enhanced angiogenesis when compared with the control and ChGelPBS groups. The anti-fibrotic effects following MSC-Exo treatment were further found to be associated with the anti-inflammatory M2 polarization of the resident macrophages, especially within the M2b subset characterized by the reduced TGFβ1 secretion, which sufficiently inhibited inflammation and prevented the activation of myofibroblast with less collagen production at the early stage after ESD. Moreover, the abundant expression of exosomal MFGE8 was identified to be involved in the transition of the M2b-macrophage subset through the activation of MFGE8/STAT3/Arg1 axis. CONCLUSIONS Our study demonstrates that exosomal MFGE8 significantly promotes the polarization of the M2b-macrophage subset, consequently reducing collagen deposition. These findings suggest a promising potential for MSC-Exo therapy in preventing the development of esophageal stricture after near-circumferential ESD.
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Affiliation(s)
- Huasheng Lai
- Department of Gastroenterology and Hepatology, Guangzhou Key Laboratory of Digestive Diseases, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, People's Republic of China
- Department of Surgery and State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China
| | - Hon-Chi Yip
- Department of Surgery and State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China
| | - Yu Gong
- Department of Endoscopy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Kai-Fung Chan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China
- Chow Yuk Ho Technology Center for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China
| | - Kevin Kai-Chung Leung
- Department of Surgery and State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China
| | - Melissa Shannon Chan
- Department of Surgery and State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China
| | - Xianfeng Xia
- Department of Surgery and State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China.
- Department of Endoscopy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- Chow Yuk Ho Technology Center for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China.
| | - Philip Wai-Yan Chiu
- Department of Surgery and State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China.
- Chow Yuk Ho Technology Center for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, 999077, People's Republic of China.
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Hou R, Hu B, Zhao X. Better understanding of post-ESD esophageal stricture would help develop a method to reduce stricture formation. Asian J Surg 2024; 47:1458-1459. [PMID: 38110325 DOI: 10.1016/j.asjsur.2023.11.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023] Open
Affiliation(s)
- Ruirui Hou
- Department of Gastroenterology, General Hospital of Ningxia Medical University, No 804 Shengli Street, Xingqing District, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Bowen Hu
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, China
| | - Xiaohong Zhao
- Department of Gastroenterology, General Hospital of Ningxia Medical University, No 804 Shengli Street, Xingqing District, Yinchuan City, Ningxia Hui Autonomous Region, China.
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Wang Y, Su Y, Zhu Y, Ni P, Yu T, Yuan T, Sun X, Shan J. Research on triamcinolone-loaded thermosensitive chitosan hydrogels for preventing esophageal stricture induced by endoscopic submucosal dissection. Int J Biol Macromol 2024; 261:129679. [PMID: 38286381 DOI: 10.1016/j.ijbiomac.2024.129679] [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: 11/09/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
Early-stage esophageal cancer is primarily treated by endoscopic submucosal dissection (ESD). However, extensive mucosal dissection creates a significant risk of postoperative esophageal stricture. Clinically, postoperative stricture can be prevented by glucocorticoids; however, there are drawbacks to both systemic and local administration of glucocorticoids, and improving drug administration methods is crucial. In this study, we developed a chitosan-based thermosensitive hydrogel for triamcinolone (TA) delivery. Our results indicated that the hydrogel remains liquid at low temperatures and can be injected into the esophageal wound site through an endoscopic biopsy channel. Upon reaching body temperature, the hydrogel undergoes spontaneous gelation and firmly adheres to the wound surface. The liquid phase enables convenient and precise delivery, while the gel phase achieves remarkable adhesion, tensile strength, and resistance to degradation. Moreover, the hydrogel exhibited an extended release duration of >10 days when loaded with a 10 mg dose. In vitro studies revealed that the hydrogel suppresses the proliferation and fibrogenesis of human scar fibroblasts (HKF). In a rat skin dermal defect model, the hydrogel attenuated keloid formation during the healing process. Consequently, the chitosan-based thermosensitive hydrogel developed in this study for triamcinolone delivery may be an effective tool for preventing post-ESD esophageal stricture.
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Affiliation(s)
- Yi Wang
- North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Yang Su
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu 610031, Sichuan, China; Department of Gastroenterology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, College of Medicine, Southwest Jiaotong University, Chengdu 610031, Sichuan, China
| | - Yuchun Zhu
- North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Panxianzhi Ni
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan 610064, China; Sichuan Testing Centre for Biomaterials and Medical Devices, Chengdu, Sichuan 610064, China
| | - Tai Yu
- North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Tun Yuan
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan 610064, China; Sichuan Testing Centre for Biomaterials and Medical Devices, Chengdu, Sichuan 610064, China
| | - Xiaobin Sun
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, College of Medicine, Southwest Jiaotong University, Chengdu 610031, Sichuan, China
| | - Jing Shan
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, College of Medicine, Southwest Jiaotong University, Chengdu 610031, Sichuan, China.
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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.
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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.
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Yang F, Hu Y, Shi Z, Liu M, Hu K, Ye G, Pang Q, Hou R, Tang K, Zhu Y. The occurrence and development mechanisms of esophageal stricture: state of the art review. J Transl Med 2024; 22:123. [PMID: 38297325 PMCID: PMC10832115 DOI: 10.1186/s12967-024-04932-2] [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: 10/18/2023] [Accepted: 01/26/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Esophageal strictures significantly impair patient quality of life and present a therapeutic challenge, particularly due to the high recurrence post-ESD/EMR. Current treatments manage symptoms rather than addressing the disease's etiology. This review concentrates on the mechanisms of esophageal stricture formation and recurrence, seeking to highlight areas for potential therapeutic intervention. METHODS A literature search was conducted through PUBMED using search terms: esophageal stricture, mucosal resection, submucosal dissection. Relevant articles were identified through manual review with reference lists reviewed for additional articles. RESULTS Preclinical studies and data from animal studies suggest that the mechanisms that may lead to esophageal stricture include overdifferentiation of fibroblasts, inflammatory response that is not healed in time, impaired epithelial barrier function, and multimethod factors leading to it. Dysfunction of the epithelial barrier may be the initiating mechanism for esophageal stricture. Achieving perfect in-epithelialization by tissue-engineered fabrication of cell patches has been shown to be effective in the treatment and prevention of esophageal strictures. CONCLUSION The development of esophageal stricture involves three stages: structural damage to the esophageal epithelial barrier (EEB), chronic inflammation, and severe fibrosis, in which dysfunction or damage to the EEB is the initiating mechanism leading to esophageal stricture. Re-epithelialization is essential for the treatment and prevention of esophageal stricture. This information will help clinicians or scientists to develop effective techniques to treat esophageal stricture in the future.
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Affiliation(s)
- Fang Yang
- Health Science Center, Ningbo University, Ningbo, 315211, People's Republic of China
| | - Yiwei Hu
- Health Science Center, Ningbo University, Ningbo, 315211, People's Republic of China
| | - Zewen Shi
- Health Science Center, Ningbo University, Ningbo, 315211, People's Republic of China
- Ningbo No.2 Hospital, Ningbo, 315001, People's Republic of China
| | - Mujie Liu
- Health Science Center, Ningbo University, Ningbo, 315211, People's Republic of China
| | - Kefeng Hu
- The First Affiliated Hospital of Ningbo University, Ningbo, 315000, People's Republic of China
| | - Guoliang Ye
- The First Affiliated Hospital of Ningbo University, Ningbo, 315000, People's Republic of China
| | - Qian Pang
- Health Science Center, Ningbo University, Ningbo, 315211, People's Republic of China
| | - Ruixia Hou
- Health Science Center, Ningbo University, Ningbo, 315211, People's Republic of China
| | - Keqi Tang
- Institute of Mass Spectrometry, School of Material Science and Chemical Engineering, Ningbo University, Ningbo, 315211, People's Republic of China.
| | - Yabin Zhu
- Health Science Center, Ningbo University, Ningbo, 315211, People's Republic of China.
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Mizuno J, Urabe Y, Oka S, Konishi H, Ishibashi K, Fukuhara M, Tanaka H, Tsuboi A, Yamashita K, Hiyama Y, Kotachi T, Takigawa H, Yuge R, Hiyama T, Tanaka S. Predictive factors for esophageal stenosis in patients receiving prophylactic steroid therapy after endoscopic submucosal dissection for esophageal squamous cell carcinoma. BMC Gastroenterol 2024; 24:41. [PMID: 38245690 PMCID: PMC10799525 DOI: 10.1186/s12876-024-03135-9] [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: 08/02/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Methods to prevent esophageal stenosis (ES) after endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (ESCC) have received increasing attention. Although steroid administration is a prophylactic treatment, the risk factors for ES during prophylactic steroid therapy remain unknown. Therefore, this study aimed to retrospectively evaluate the risk factors for refractory ES in patients administered prophylactic steroids after ESD for ESCC. METHODS Among 795 patients with ESCC (854 lesions), 180 patients (211 lesions) administered local triamcinolone acetonide (TrA) and/or oral prednisolone were recruited for this study. We compared the total number of endoscopic balloon dilatation (EBD) procedures performed for post-ESD ES and clinical findings (tumor size, ESD history or chemoradiation therapy [CRT], entire circumferential resection, muscle layer damage, supplemental oral prednisolone administration, EBD with TrA injection, and additional CRT) between patients with refractory and non-refractory ES. EBD was continued until dysphagia resolved. We categorized cases requiring ≥ 8 EBD procedures as refractory postoperative stenosis and divided the lesions into two groups. RESULTS Multivariate logistic regression analysis revealed that factors such as ESD history, CRT history, tumor size, and entire circumferential resection were independently associated with the development of refractory ES. The withdrawal rates of EBD at 3 years were 96.1% (52/53) and 58.5% (39/59) in the non-refractory and refractory groups, respectively. CONCLUSIONS Our data suggest that entire circumferential resection and CRT history are risk factors for refractory post-ESD ES in ESCC, even with prophylactic steroid administration.
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Affiliation(s)
- Junichi Mizuno
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Yuji Urabe
- Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Shiro Oka
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Hirona Konishi
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Kazuki Ishibashi
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Motomitsu Fukuhara
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Akiyoshi Tsuboi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuichi Hiyama
- Department of Hiroshima Clinical Research and Development Support Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Takahiro Kotachi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidehiko Takigawa
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ryo Yuge
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Toru Hiyama
- Health Service Center, Hiroshima University, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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Su S, Pang T, Wang Y, Chen J. Prevention of Esophageal Stricture after Endoscopic Submucosal Dissection with an Autologous Esophageal Epithelial Cell Suspension: An Animal Study. Discov Med 2023; 35:1026-1034. [PMID: 38058067 DOI: 10.24976/discov.med.202335179.98] [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] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND Severe esophageal stricture decreases patient's quality of life after circumferential endoscopic submucosal dissection (ESD). We aimed to evaluate the efficacy of autologous esophageal epithelial cell suspensions in preventing esophageal stricture after circumferential ESD. METHODS Twelve male mini-pigs underwent circumferential ESD and were randomized into four groups: G1 (control), G2 (esophageal stent), G3 (autologous esophageal epithelial cell suspension), and G4 (autologous esophageal epithelial cell suspension combined with esophageal stent). Post-ESD status was observed in each group, and endoscopy was performed weekly. Esophageal stents were removed 3 weeks after ESD. The esophageal stricture rates and histologic characteristics were assessed 4 weeks after ESD. RESULTS G1 showed the greatest weight loss (p < 0.05). Dysphagia scores were not significantly different among the groups. The esophageal mucosal stricture rates were 77.7 ± 2.9%, 74.2 ± 1.9%, 69.2 ± 3.8% and 65.9 ± 1.9% in G1-4, respectively; with the highest in G1 (G1 vs. G3, p = 0.005; G1 vs. G4, p = 0.001). The regenerated epithelium lengths were 4.408 ± 1.980 mm, 8.319 ± 0.857 mm, 11.801 ± 2.455 mm and 12.353 ± 1.111 mm in G1-4, respectively. The lowest degree of re-epithelialization was observed in G1, followed by G2, with the highest degrees in G3 and G4 (G1 vs. G3, p = 0.001; G1 vs. G4, p = 0.000). The maximum wound fibrosis thicknesses were 2.546 ± 0.389 mm, 2.136 ± 0.231 mm, 1.126 ± 0.211 mm and 1.131 ± 0.438 mm in G1-4, respectively, with higher degrees in G1 and G2 than in G3 and G4 (G1 vs. G3, p = 0.001; G1 vs. G4, p = 0.001). CONCLUSIONS Autologous esophageal epithelial cell suspensions can promote re-epithelialization and reduce fibrosis, thus decreasing esophageal stricture severity after ESD.
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Affiliation(s)
- Shengchang Su
- The Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 200433 Shanghai, China
| | - Tingting Pang
- The Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 200433 Shanghai, China
| | - Yunfeng Wang
- The Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 200433 Shanghai, China
| | - Jie Chen
- The Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 200433 Shanghai, China
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Ladd AM, Park K, Bilal M, Schlachterman A, Amin S, Obeng G, Khan A, Thakkar S. Prophylactic stenting to decrease the incidence of esophageal strictures after extensive endoscopic submucosal dissection: the first U.S. experience. Gastrointest Endosc 2023; 98:1000-1003. [PMID: 37500020 DOI: 10.1016/j.gie.2023.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/23/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Antonio Mendoza Ladd
- Department of Internal Medicine, Division of Gastroenterology, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA.
| | - Kenneth Park
- Cedars-Sinai Health System, Los Angeles, California, USA
| | - Mohammad Bilal
- Division of Gastroenterology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Sunil Amin
- University of Miami School of Medicine, Miami, Florida, USA
| | - George Obeng
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University, Morgantown, West Virginia, USA
| | - Adnan Khan
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Shyam Thakkar
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University, Morgantown, West Virginia, USA
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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.
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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.
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Suzuki Y, Koseki M, Matsui A, Kikuchi D, Hoteya S. Complete Circumferential Endoscopic Submucosal Dissection for Esophageal Cancer Leaving an Island of Normal Mucosa. Intern Med 2023; 62:3131-3135. [PMID: 36889701 PMCID: PMC10686731 DOI: 10.2169/internalmedicine.1637-23] [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: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023] Open
Abstract
Esophageal stricture caused by complete circumferential endoscopic submucosal dissection (ESD) of extensive esophageal squamous cell carcinoma (ESCC) is a major concern and can result in a low quality of life. Normal mucosa may remain within a complete circumferential lesion of ESCC in some cases. We herein report a case of ESCC in which a complete circumferential lesion was treated with ESD while leaving an island of normal mucosa within it. This case demonstrates that preserving areas of normal mucosa within lesions during complete circumferential ESD is not technically difficult and may be an effective measure for preventing esophageal stricture.
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Affiliation(s)
- Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Mako Koseki
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Japan
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12
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Pan Q, Tsuji Y, Sreedevi Madhavikutty A, Ohta S, Fujisawa A, Inagaki NF, Fujishiro M, Ito T. Prevention of esophageal stenosis via in situ cross-linkable alginate/gelatin powder in a new submucosal exfoliation model in rats. Biomater Sci 2023; 11:6781-6789. [PMID: 37614197 DOI: 10.1039/d3bm00887h] [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] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Endoscopic submucosal dissection (ESD) for the treatment of esophageal mucosal lesions often leads to postoperative stenosis, causing difficulty in swallowing, known as dysphagia. In this study, we developed an in situ cross-linkable powder composed of alginate, gelatin, transglutaminase (TG), and calcium chloride ions (Ca2+), which can be administered through a 1.5 m-long and 3.2 mm-diameter endoscopic instrument channel. The powdered mixture of alginate and gelatin quickly formed a hydrogel by absorbing body fluids and was cross-linked by TG and Ca2+, which adhered ex vivo to porcine submucosal layers for over 2 weeks. In addition, we developed a new submucosal exfoliation model in rats that induced severe stenosis, similar to the ESD-induced stenosis models in clinical practice. When administered to the new rat model, the powder system effectively reduced the severity of esophageal stenosis based on body weight change monitoring, anatomical findings, and histological analysis. The body weight of the rats was maintained at the initial weight on postoperative day 14 (POD14), and epithelialization on POD7 and 14 improved to almost 100%. Additionally, collagen accumulation and the number of α-SMA-positive cells decreased due to powder administration. Therefore, these findings indicate that the in situ cross-linkable powder can prevent esophageal stenosis after ESD.
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Affiliation(s)
- Qi Pan
- Center for Disease Biology and Integrative Medicine, School of Medicine, the University of Tokyo, Japan.
| | - Yosuke Tsuji
- Department of Gastroenterology, School of Medicine, the University of Tokyo, Japan
| | | | - Seiichi Ohta
- Center for Disease Biology and Integrative Medicine, School of Medicine, the University of Tokyo, Japan.
- Institute of Engineering Innovation, School of Engineering, the University of Tokyo, Japan
- Department of Bioengineering, School of Engineering, the University of Tokyo, Japan
| | - Ayano Fujisawa
- Department of Bioengineering, School of Engineering, the University of Tokyo, Japan
| | - Natsuko F Inagaki
- Center for Disease Biology and Integrative Medicine, School of Medicine, the University of Tokyo, Japan.
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, School of Medicine, the University of Tokyo, Japan
| | - Taichi Ito
- Center for Disease Biology and Integrative Medicine, School of Medicine, the University of Tokyo, Japan.
- Department of Chemical System Engineering, School of Engineering, the University of Tokyo, Japan
- Department of Bioengineering, School of Engineering, the University of Tokyo, Japan
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13
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Wyllie T, Folaranmi E, Sekaran P, Watkins WJ, Chakraborty M. Prophylactic Acid-suppression Medication to Prevent Anastomotic Strictures After Oesophageal Atresia Surgery: A Systematic Review and Meta-analysis. J Pediatr Surg 2023; 58:1954-1962. [PMID: 37355433 DOI: 10.1016/j.jpedsurg.2023.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/18/2022] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Anastomotic stricture is a common postoperative complication of oesophageal atresia ± tracheoesophageal fistula (OA/TOF) repair. Acid gastro-oesophageal reflux disease (GORD) is considered to be a factor in stricture formation and acid suppression medication is recommended post-operatively in consensus guidance. We aimed to investigate whether patients who were treated prophylactically with acid suppression medication had a reduced incidence of strictures compared to those who did not receive it. METHODS A systematic review of studies was performed, searching multiple databases without language or date restrictions. Multiple reviewers independently assessed study eligibility and literature quality. The primary outcome was anastomotic stricture formation, with secondary outcomes of GORD, anastomotic leak, and oesophagitis. Meta-analysis was performed using a random effects model, and the results were expressed as an odds ratio (OR) with 95% confidence intervals (CI). RESULTS No randomised studies on the topic were identified. Twelve observational studies were included in the analysis with ten reporting the primary outcome. The quality assessment showed a high risk of bias in several papers, predominantly due to non-objective methods of assessment of oesophageal stricture and the non-prospective, non-randomised nature of the studies. Overall, 1395 patients were evaluated, of which 753 received acid suppression medication. Meta-analysis revealed a trend towards increased odds of anastomotic strictures in infants receiving prophylactic medication, but this was not statistically significant (OR 1.33; 95% CI 0.92, 1.92). No significant differences were found in secondary outcomes. CONCLUSIONS This meta-analysis found no evidence of a statistically significant link between the prophylactic prescribing of acid suppression medication and the risk of developing anastomotic stricture after OA repair. The literature in this area is limited to observational studies and a randomised controlled trial is recommended to explore this question. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thomas Wyllie
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Eniola Folaranmi
- Department of Paediatric Surgery, University Hospital of Wales, Cardiff, UK
| | - Prabhu Sekaran
- Department of Paediatric Surgery, University Hospital of Wales, Cardiff, UK
| | - W John Watkins
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK; Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
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14
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Fu Y, Zhao H, Li J, Li Y, Gong T, An C, Wang R, Li X. Infigratinib, a Selective Fibroblast Growth Factor Receptor Inhibitor, Suppresses Stent-Induced Tissue Hyperplasia in a Rat Esophageal Model. Cardiovasc Intervent Radiol 2023; 46:1267-1275. [PMID: 37491520 DOI: 10.1007/s00270-023-03502-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE Stent-induced tissue hyperplasia remains a challenge for the application of self-expanding metal stents in the management of esophageal stricture. This study aimed to evaluate the efficacy of infigratinib, which is a selective fibroblast growth factor receptor inhibitor, in the prevention of stent-induced tissue hyperplasia in a rat esophageal model. METHODS Twenty-four male Sprague-Dawley rats underwent esophageal stent placement and were randomized to receive 1 ml of vehicle, 5 mg/kg infigratinib in 1 ml of vehicle, or 10 mg/kg infigratinib in 1 ml of vehicle via naso-gastric tube once daily for 28 days. Follow-up fluoroscopy was performed on postoperative day 28, and the stented esophageal tissues were harvested for histological and immunofluorescence examinations. RESULTS All rats survived until euthanasia on postoperative day 28 without procedure-related adverse events. The incidence of stent migration was 12.5%, 12.5% and 25% in the control group, the 5 mg/kg infigratinib group and, the 10 mg/kg infigratinib group, respectively. The percentage of granulation tissue area, the submucosal fibrosis thickness, the number of epithelial layers, the degree of inflammatory cell infiltration, the degree of collagen deposition, the number of fibroblast growth factor receptor 1 (FGFR1)-expressing myofibroblasts, and the number of proliferating myofibroblasts were all significantly lower in both infigratinib groups than in the control group (P < 0.05) but were not significantly different between the two infigratinib groups (P > 0.05). CONCLUSIONS Infigratinib significantly suppresses stent-induced tissue hyperplasia by inhibiting FGFR1-mediated myofibroblast proliferation and profibrotic activities in a rat esophageal model.
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Affiliation(s)
- Yan Fu
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - He Zhao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jingui Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yawei Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Tao Gong
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Chao An
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ruosu Wang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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15
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Miyake M, Ishihara R, Matsuura N, Ueda T, Okubo Y, Kawakami Y, Tani Y, Yoshii S, Shichijo S, Kanesaka T, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Michida T, Matsunaga T. Predictors of stricture after non-circumferential endoscopic submucosal dissection of the esophagus and single-dose triamcinolone injection immediately after the procedure. Gastrointest Endosc 2023; 98:170-177. [PMID: 36990127 DOI: 10.1016/j.gie.2023.03.017] [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: 02/03/2023] [Revised: 03/05/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND AND AIMS Local triamcinolone (TA) injection is widely used to prevent stricture formation after endoscopic submucosal dissection (ESD). However, stricture develops in up to 45% of patients despite this prophylactic measure. We therefore conducted a single-center prospective study to identify predictors of stricture after esophageal ESD and local TA injection. METHODS Patients who underwent esophageal ESD and local TA injection and who were comprehensively assessed for lesion- and ESD-related factors were included in the study. Multivariate analyses were conducted to identify the predictors of stricture. RESULTS A total of 203 patients were included in the analysis. Multivariate analysis identified residual mucosal width ≤5 mm (odds ratio [OR], 29.0; P < .0001) or 6 to 10 mm (OR, 3.7; P = .04), history of chemoradiotherapy (OR, 5.1; P = .045), and tumor in the cervical or upper thoracic esophagus (OR, 3.8; P = .018) as independent predictors of stricture. Based on the ORs of the predictors, patients were stratified into 2 groups according to stricture risk: patients in the high-risk group (residual mucosal width ≤5 mm or 6-10 mm with another predictor) had a stricture rate of 52.5% (31 of 59 cases), and patients in the low-risk group (residual mucosal width ≥11 mm or 6-10 mm without other predictors) had a stricture rate of 6.3% (9 of 144 cases). CONCLUSIONS We identified predictors of stricture after ESD and local TA injection. Local TA injection prevented stricture formation after ESD in low-risk patients but was not sufficient to prevent stricture in high-risk patients. Additional interventions should thus be considered in high-risk patients. (University Hospital Medical Network Clinical Trials Registry number: UMIN 000028894.).
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Affiliation(s)
| | | | - Noriko Matsuura
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | - Takashi Matsunaga
- Department of Medical Informatics, Osaka International Cancer Institute, Osaka, Japan
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16
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Li L, Wang Z, Wang N, Zhang B, Zou J, Xiang J, Du C, Xu N, Wang P, Wang X, Feng J, Linghu E, Chai N. Self-help inflatable balloon versus autologous skin-grafting surgery for preventing esophageal stricture after complete circular endoscopic submucosal dissection: a propensity score matching analysis. Surg Endosc 2023; 37:3710-3719. [PMID: 36650352 DOI: 10.1007/s00464-022-09789-4] [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: 05/13/2022] [Accepted: 11/27/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The self-help inflatable balloon (SHIB) and autologous skin-grafting surgery (ASGS) were used to prevent stricture after esophageal complete circular endoscopic submucosal dissection (cESD) with promising clinical results. We aim to evaluate which method is more suitable for patients who underwent esophageal cESD. METHODS From October 2017 to July 2021, patients whose mucosal defect length were between 30 and 100 mm after esophageal cESD were retrospectively reviewed from two prospective studies. They were enrolled once SHIB or ASGS was used as preventive methods to prevent stricture. Propensity score matching (PSM) was used to balance the baseline characteristics between the two groups. Comparisons were made between the two groups, including operation time, the longitudinal length of ulceration, fasting time, hospitalization days, and the incidence of stricture. RESULTS A total of 41 patients who met the inclusion criteria were enrolled in the study. The numbers of patients in SHIB group and ASGS group were 25 and 16, respectively. Fifteen patients in each group were selected after performing PSM. The basic baseline characteristics were comparable between the two groups. The stricture rates were 20% (3/15) in SHIB group and 40% (6/15) in ASGS group, while the difference was not statistically significant (p = 0.427). The SHIB group showed significantly shorter operation time, shorter hospitalization days, lower cost, and longer removing balloon/stent time compared with ASGS group (p < 0.001). Comparison of relevant stricture factors between the stricture group and non-stricture group revealed that longer longitudinal length of ulceration (> 60 mm) accounted for a higher proportion in stricture groups (p = 0.035). CONCLUSION Both the SHIB and ASGS had high efficacy and safety in preventing strictures in patients with mucosal defects no longer than 100 mm in length after esophageal cESD. The longitudinal length of ulceration > 60 mm was the independent factor for predicting stricture.
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Affiliation(s)
- Longsong Li
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zixin Wang
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Nanjun Wang
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bo Zhang
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jiale Zou
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jingyuan Xiang
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Chen Du
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Ning Xu
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Pengju Wang
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiangyao Wang
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jiancong Feng
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Enqiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Ningli Chai
- Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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17
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Peng S, Huang S, Xia H, Tan S, Zhong C, Peng Y, Lü M, Tang X. The role of polyglycolic acid sheets in the management of post-endoscopic submucosal dissection gastrointestinal bleeding and esophageal stricture: A PRISMA compliant systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29770. [PMID: 35776992 PMCID: PMC9239659 DOI: 10.1097/md.0000000000029770] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As a relatively minimally invasive technique, endoscopic submucosal dissection (ESD) is widely used for the treatment of gastrointestinal lesions. However, it is associated with complications, such as postoperative bleeding, stricture, and perforation. A covering method using polyglycolic acid (PGA) sheets for ESD-induced ulcers has been reported to be effective in reducing the risk of post-ESD bleeding and esophageal stricture. Herein, we conducted a systematic review and meta-analysis to evaluate the role of PGA sheets in the prevention of gastrointestinal bleeding and esophageal stricture after ESD. METHODS We searched PubMed, Web of Science, and the Cochrane Library databases on October 15, 2019. All eligible articles were selected based on the predefined inclusion and exclusion criteria. The main outcomes were the rates of post-ESD gastrointestinal bleeding and esophageal stricture. Cochrane's Q statistic and I2 test were used to identify heterogeneity between the studies. When there was no obvious heterogeneity (I2 < 50%, P > .1), a fixed-effect model was used. When there was obvious heterogeneity (I2 > 50%, P < .1), a random effect model was used. Funnel plots and the Egger regression test were used to assess publication bias. RESULTS Fifteen articles were included in the meta-analysis, of which 7 were exclusively about the use of PGA sheets to prevent postoperative gastrointestinal bleeding, and the remaining reported the use of PGA sheets to prevent postoperative esophageal stenosis. Our analysis showed that preventive therapy with PGA sheets decreased the rates of post-ESD gastrointestinal bleeding (risk ratio [RR] = 0.35, 95% confidential interval [CI]: 0.19-0.64, P < .001) and esophageal stricture (RR = 0.46, 95% CI: 0.27-0.79, P = .005), and the gastrointestinal bleeding and esophageal stricture rates after preventive treatment with PGA sheets were 5.7% (95% CI: 3.6%-8.8%) and 20.6% (95% CI: 14.5%-28.4%), respectively. CONCLUSION The utilization of PGA sheets after ESD has an excellent outcome in reducing the risk of postoperative gastrointestinal bleeding and esophageal stricture.
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Affiliation(s)
- Shicheng Peng
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Gastroenterology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Shu Huang
- Department of Gastroenterology, the People’s Hospital of Lianshui, Huaian, China
| | - Huifang Xia
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shali Tan
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chunyu Zhong
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Peng
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Muhan Lü
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaowei Tang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
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18
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Wu HL, Chen L, Wei M, Lu Q, Li N, Wang GQ, Shi RH. [Effect and mechanism of glucocorticoids in preventing stenosis after esophageal endoscopic submucosal dissection]. Zhonghua Yi Xue Za Zhi 2022; 102:1506-1511. [PMID: 35692065 DOI: 10.3760/cma.j.cn112137-20210905-02024] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To explore the role and specific mechanism of glucocorticoids in preventing stenosis after esophageal endoscopic submucosal dissection (ESD). Methods: Data of 81 patients [51 cases were male and 30 cases were female, aged (62.09±7.95) years] undergoing early esophageal cancer or precancerous lesions with a stripping range ≥3/4 circle hospitalized from January 2019 to February 2021 in Department of Gastroenterology, Zhongda Hospital, Southeast University. They were randomly divided into the control group (n=23), oral prednisone acetate group (n=28) and/or combined with local injection Triamcinolone acetonide group (n=30). Analysis the stenosis rates, endoscopic stent dilatation times, the scores of the Atkinson classification and QLQ-OES18 after 12 weeks. Also the expression of carbohydrate sulfotransferase15 (CHST15) mRNA, TGF-β1 and Collagen-Ⅰ protein were compared by real-time PCR or immunohistochemistry. Results: The stenosis rates of the control group, oral prednisone acetate group and/or combined with local injection Triamcinolone acetonide group were 82.6% (19/23), 46.4% (13/28) and 20.0% (6/30) (P<0.001); endoscopic stent dilatation times [M (Q1,Q3)] in these three groups were 2 (1, 3), 0 (0, 0) and 0 (0, 0) (P<0.001). After ESD, the scores of the Atkinson classification and QLQ-OES18 in the three groups were lower than before (P<0.001); and the expression of CHST15 mRNA in the three groups were 4.31±0.13, 3.44±0.07 and 2.84±0.21 respectively (P<0.001). Compared with the control group, the expression of CHST15 mRNA in oral prednisone acetate group was down-regulated (P<0.001), and was the lowest in oral prednisone acetate combined with local injection Triamcinolone acetonide group (P<0.001). As CHST15 mRNA was down-regulated, the expression of TGF-β1 and Collagen-I protein was also down-regulated (P<0.05). Conclusions: Oral prednisone alone or combined with local injection of triamcinolone acetonide both can prevent esophageal stenosis effectively. Oral combined with local injection of glucocorticoid is particularly more effective. Glucocorticoid can reduce the expression of CHST15 mRNA, thereby inhibiting the expression of TGF-β1 and Collagen-I protein.
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Affiliation(s)
- H L Wu
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - L Chen
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - M Wei
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Q Lu
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - N Li
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - G Q Wang
- Department of Pathology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - R H Shi
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing 210009, China
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19
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Zhang Y, Mao XL, Zhu W, Zheng HH, Zhou SK, Ye LP, Li YM. Esophageal Mucosal Autograft for Preventing Stricture After Widespread Endoscopic Submucosal Dissection of Superficial Esophageal Lesions. Turk J Gastroenterol 2022; 33:312-319. [PMID: 35550539 PMCID: PMC9153302 DOI: 10.5152/tjg.2021.201032] [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] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/14/2021] [Indexed: 09/17/2023]
Abstract
BACKGROUND Although esophageal mucosal autograft prevents esophageal stricture after widespread endoscopic submucosal dissec- tion and has been reported as a new technique, it is relatively unproven in clinical practice. This prospective study was conducted to evaluate our experience using esophageal mucosal autograft to prevent strictures after widespread endoscopic submucosal dissection in patients with widespread superficial esophageal lesions. METHODS Between October 2017 and June 2018, 15 patients with widespread superficial esophageal lesions were consecutively treated with widespread endoscopic submucosal dissection and then underwent esophageal mucosal autograft. The main outcomes measured included esophageal epithelialization and esophageal stricture. RESULTS The median longitudinal diameter of the widespread superficial esophageal lesions was 5.2 cm. All 15 patients were success- fully treated with widespread endoscopic submucosal dissection and esophageal mucosal autograft, and the median procedural time was 182 minutes. During follow-up (median, 23 months), esophageal epithelialization was found in 13 patients (86.7%), and 7 patients experienced esophageal stricture (46.7%). In those 7 patients, the esophageal strictures were successfully relieved after endoscopic bal- loon dilation or endoscopic radial incision. No complications related to endoscopic balloon dilation/endoscopic radial incision occurred. Additionally, local recurrence was found in 1 patient with poorly differentiated squamous cell carcinoma, and further surgical resection was performed. CONCLUSIONS Esophageal mucosal autograft appears to be an efficient approach to reconstructing local esophageal epithelium and might have a potential role in preventing esophageal stricture after widespread endoscopic submucosal dissection. However, as a new technique, it needs more improvement to enhance its role in preventing esophageal stricture after widespread endoscopic submucosal dissection.
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Affiliation(s)
- Yu Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Zhejiang University School of Medicine, Linhai, Zhejiang Province, China
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Linhai, Zhejiang Province, China
| | - Xin-Li Mao
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Zhejiang University School of Medicine, Linhai, Zhejiang Province, China
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Linhai, Zhejiang Province, China
| | - Wei Zhu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Zhejiang University School of Medicine, Linhai, Zhejiang Province, China
| | - Shen-Kang Zhou
- Department of Gastrointestinal Surgery, Taizhou Hospital of Zhejiang Province, Zhejiang University School of Medicine, Linhai, Zhejiang Province, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Zhejiang University School of Medicine, Linhai, Zhejiang Province, China
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Linhai, Zhejiang Province, China
| | - You-Ming Li
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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20
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Shaprynskyi Y, Shaprynskyi VO, Hussein MB, Vorovskyi OO, Karyi YV. RESULTS OF PREVENTIVE METHODS OF OCCURRENCE CERVICAL ANASTOMOTIC COMPLICATIONS IN ESOPHAGOPLASTY. Wiad Lek 2022; 75:383-386. [PMID: 35307663] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim: The aim of the study was to improve the results of surgical treatment in patients with corrosive esophageal strictures using the designed comprehensive surgical management program in esophagoplasty to decrease cervical anastomotic complications. PATIENTS AND METHODS Materials and methods: The results of surgical treatment of 116 patients with esophageal strictures were studied. 45 patients had post-burn corrosive strictures, 17 - postoperative corrosive strictures, 10 - peptic strictures due to reflux esophagitis and 44 patients - esophageal cancer. All patients were divided into two groups: the control group, consisting of 55 patients who underwent conventional surgical treatment of corrosive esophageal strictures during 2005-2011, and experimental group involving 61 patients operated on during 2012- 2020, in whom an individual approach to the choice of surgical method was applied using diagnostic and treatment algorithm as well as the designed surgical management program. RESULTS Results: In early postoperative period the proportion of specific and non-specific complications was significantly lower in experimental group as compared to the control group: cervical anastomotic leak - 16.36 % versus 4.392 %; strictures of cervical anastomosis - 20.0% versus 6.56 % (p<0.05). There were six postoperative deaths - four in the control group and two in experimental group. CONCLUSION Conclusions: To prevent the development of cervical anastomotic complications and mortality in esophagoplasty proper therapeutic approach with consideration of all prognostic criteria and risk factors should be chosen and designed surgical management program should be applied.
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Affiliation(s)
| | | | | | - Oleg O Vorovskyi
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | - Yaroslav V Karyi
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
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21
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Spaulding SL, Ansari E, Xing MH, Sandler ML, O'Malley QF, Ho R, Spitzer H, Levy J, Ganz C, Khorsandi AS, Mundi N, Urken ML. Diagnosis and management of pharyngoesophageal stenosis: A comprehensive approach to prophylactic, endoscopic, and reconstructive treatment options. Am J Otolaryngol 2021; 42:103003. [PMID: 33894689 DOI: 10.1016/j.amjoto.2021.103003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pharyngoesophageal stenosis (PES) is a serious complication that substantially impacts functional outcomes and quality of life (QOL) for up to a third of head and neck cancer patients who undergo radiotherapy. Dysphagia is often multifactorial in nature and is a devastating complication of treatment that impacts patients' QOL, general health and overall wellbeing. The authors detail the clinical presentation, risk factors, imaging characteristics, preventive measures, and multimodality treatment options for PES. METHODS The authors present a comprehensive management algorithm for PES, including treatment by dilation, stenting, spray cryotherapy and dilation, and reconstructive treatment options utilizing different pedicled and free flaps. RESULTS The authors advocate for a thorough assessment of the extent and degree of pharyngoesophageal involvement of PES to determine the optimal management strategy. CONCLUSIONS The development of post treatment dysphagia requires appropriate imaging and biopsy, when indicated, to rule out the presence of persistent/recurrent cancer. Multidisciplinary management by a team of physicians well-versed in the range of diagnostic and therapeutic interventions available for PES is critical to its successful management.
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Affiliation(s)
- Sarah L Spaulding
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Edward Ansari
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America.
| | - Mykayla L Sandler
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Quinn F O'Malley
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Rebecca Ho
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Hannah Spitzer
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Juliana Levy
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Cindy Ganz
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary, New York, NY 10003, United States of America
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
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22
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Djabali EJ, Rotter J, Chheda NN, Amdur RJ, Hitchcock K, Mendenhall W, Dziegielewski PT. Woody hardness classification impact on salvage laryngectomy functional outcomes. Am J Otolaryngol 2021; 42:102877. [PMID: 33485049 DOI: 10.1016/j.amjoto.2020.102877] [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: 11/16/2020] [Accepted: 12/25/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Post-radiation therapy salvage surgeries are challenging for surgeons due to tissue fibrosis. The woody hardness classification is valuable in differentiating the degree of neck stiffness, but its clinical utility has not been evaluated. We applied it to patients undergoing salvage laryngectomy to study the impact of woody hardness on postoperative outcomes. MATERIALS AND METHODS A retrospective observational study was performed on patients undergoing salvage laryngectomy between 2014 and 2019. Patients were assigned into the A (extremely woody hard), B (moderately woody hard), or C (mildly woody hard) woody hardness class. The primary outcome was pharyngoesophageal stricture development. Secondary outcomes included time to pharyngoesophageal stricture, pharyngocutaneous fistula development, time to pharyngocutaneous fistula, development of post-operative complications, and tracheoesophageal puncture complications. RESULTS Fifty-one patients were included in the study: Class A 1 patient, Class B 30 patients, and Class C 20 patients. The single Class A patient was grouped with the Class B patients. The development of a pharyngoesophageal stricture shows consistent negative association with woody hardness despite most analyses not reaching statistical significance. These associations are robust to a number of confounding variables in multivariate logistic and time to event analyses. Furthermore, the time to event analysis controlling for squamous cell carcinoma diagnosis led to a statistically significant association between woody hardness (i.e., A/B higher risk) and time to stricture (HR=5, p=0.02). CONCLUSIONS This study suggests that this classification may be useful in predicting pharyngoesophageal stricture formation in salvage laryngectomy patients and could be used to implement stricture preventive measures.
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Affiliation(s)
- Emma J Djabali
- College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, USA.
| | - Jason Rotter
- Mathematica, Inc., 1100 First St. NE, #1200, Washington, DC, USA
| | - Neil N Chheda
- Department of Otolaryngology, University of Florida, PO Box 100264 1345, Center Dr., M2-228 MSB, Gainesville, FL, USA
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
| | - Kathryn Hitchcock
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, PO Box 100264 1345, Center Dr., M2-228 MSB, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
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23
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Simsek M, Mert M. A New Approach to Tense End-to-End Anostomosis in Primary Surgical Repair of Esophageal Atresia: Vascularized Pleural Flap. Chirurgia (Bucur) 2021; 116:60-65. [PMID: 33638327 DOI: 10.21614/chirurgia.116.1.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
Background: Esophageal atresia (EA) is the most common congenital malformation of the esophagus. If the distance between the proximal and distal pouches is usually more than 2-3 cm, it is considered as long gap esophageal atresia (LGEA). In our study, it was planned to investigate the effect of the use of vascularized pleural flap (VPF) on postoperative recovery in cases with tense end-to-end anastomosis in the primary repair of LGEA. Methods: The postoperative recovery period data of patients who underwent tense end-to-end anastomosis due to LGEA between 01/01/2016 and 01/12/2020 in our clinic were analyzed retrospectively. Results: Between the specified dates, 37 patients were operated for EA. A tense end-to-end anastomosis was performed in 16 of 37 patients. In 5 of these patients, a VPF was placed on the anastomosis line. In the postoperative follow-up, no anastomotic leakage or anastomotic stenosis was observed in 5 patients who underwent tense anastomosis with VPF. In addition, it was observed that patients who underwent tense anastomosis with VPF were started oral nutrition earlier after surgery compared to patients without VPF. Conclusion: The success of the technique we performed in 5 patients without any complications suggested that this technique could be used as a method in tense anastomoses. It was thought that oral nutrition was initiated early in patients using VPF, since there was no anastomotic leak and the surgeon relied on the presence of the VPF.
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24
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Jones CE, Smyth R, Drewett M, Burge DM, Hall NJ. Association Between Administration of Antacid Medication and Anastomotic Stricture Formation After Repair of Esophageal Atresia. J Surg Res 2020; 254:334-339. [PMID: 32521372 DOI: 10.1016/j.jss.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/16/2019] [Revised: 04/15/2020] [Accepted: 05/03/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anastomotic stricture is a significant cause of morbidity after repair of esophageal atresia (EA). Exposure to gastric acid has been postulated to contribute to stricture development and severity leading to prophylactic antacid use by some surgeons. We investigated the association between administration of antacid medication and the development of anastomotic strictures. METHODS Retrospective case-note review of consecutive infants undergoing repair of EA with distal tracheoesophageal fistula (type C) between January 1994 and December 2014. Only infants who underwent primary esophageal anastomosis at initial surgical procedure were included. Stricture-related outcomes were compared initially for infants who received prophylactic antacid medication (PAAM) versus no prophylaxis, and the role of PAAM in stricture prevention was explored in a multivariate model. Outcomes were also compared for infants grouped by antacid use at any stage. RESULTS One hundred fourteen infants were included. Sixteen infants received PAAM at surgeon preference. Of the remaining 98 infants, 44 subsequently received antacid as treatment for gastroesophageal reflux (GER) and 54 never received antacid medication. There was no statistically significant association between incidence of stricture in the first year (10 of 16 versus 41 of 98; P = 0.18) nor time to first stricture (median, 57 d [41-268] versus 102 d [43-320]; P = 0.89) and administration of PAAM. Similarly, there were no statistically significant associations between incidence of stricture, age at first stricture and number of dilatations, and administration of antacid medication either as prophylaxis nor when given as treatment for symptoms or signs of GER. CONCLUSIONS These data do not support the hypothesis that PAAM reduces the incidence or severity of anastomotic stricture after repair of EA. Treatment with antacids may be best reserved for those with symptoms or signs of GER. Further prospective investigation of the role of antacid prophylaxis on stricture formation after EA repair is warranted.
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Affiliation(s)
- Ceri E Jones
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Rachel Smyth
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Melanie Drewett
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - David M Burge
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Nigel J Hall
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK; University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
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25
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Shaprynskyi VO, Shaprynskyi YV, Hussein MB, Vorovskyi OO, Karyi YV, Shaprynska LA, Dmytryshyn SP. MODERN METHODS OF PREVENTION AND TREATMENT OF COMPLICATIONS OF CERVICAL ESOPHAGO-ORGAN ANASTOMOSIS AT ESOPHAGOPLASTY. Wiad Lek 2020; 73:1696-1699. [PMID: 33055336] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim: To improve the results of operative treatment of esophageal strictures by decreasing the rate of failure and stricture of cervical esophago-organ anastomoses. PATIENTS AND METHODS Materials and methods: There were 45 patients with post-burn corrosive gullet strictures, 17 patients with postoperative corrosive strictures, 10 patients with peptic strictures secondary to reflux-esophagitis, 42 patients with esophageal cancer strictures. The patients were divided into two groups: the comparison group - 55 persons and the main group - 59 persons. Patients of comparison group underwent surgical treatment of esophageal strictures according to classic protocols and standards. In the main group of patients we applied proposed diagnostic algorithm with prediction of complication risk and the designed method of esophago-organ anastomosis formation. RESULTS Results: The results of operative treatment in patients with esophageal strictures showed the development of early postoperative complications in 59 individuals (51.75 %). In the postoperative period six patients died: four - in the comparison group and two - in the main group. Failure of cervical esophago-organ anastomosis and esophageal strictures occurred in 7 patients (11.86 %) of main group and 20 patients (36.36 %) of the comparison group (p<0.05). CONCLUSION Conclusions: Application of method predicting the risk of complications of cervical anastomosis, treatment program and instrumental method of formation anastomosis resulted in reduced incidence of failure and strictures of esophago-organ anastomosis from 36.36 % to 11.86 % (p<0.05); decreased time of hospitalization - from 28.2 ± 1.1 to 21.5 ± 0.5 bed-days (p<0.001), postoperative period - from 20.5 ± 1.1 to 16.1 ± 0.7 bed-days (p<0.01); decreased postoperative mortality - from 7.27 % to 3.39 %.
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Affiliation(s)
| | | | | | - Oleg O Vorovskyi
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | - Yaroslav V Karyi
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
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Ten Kate CA, Vlot J, IJsselstijn H, Allegaert K, Spaander MCW, Poley MJ, van Rosmalen J, van den Akker ELT, Wijnen RMH. Intralesional steroid injections to prevent refractory strictures in patients with oesophageal atresia: study protocol for an international, multicentre randomised controlled trial (STEPS-EA trial). BMJ Open 2019; 9:e033030. [PMID: 31848172 PMCID: PMC6937109 DOI: 10.1136/bmjopen-2019-033030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Anastomotic stricture formation is the most common postoperative complication after oesophageal atresia (OA) repair. The standard of care is endoscopic dilatation. A possible adjuvant treatment is intralesional steroid injection, which is thought to inhibit scar tissue formation and thereby to prevent stricture recurrence. We hypothesise that this intervention could prevent refractory strictures and reduce the total number of dilatations needed in these children. METHODS AND ANALYSIS This is an international multicentre randomised controlled trial. Children with OA type C (n=110) will be randomised into intralesional steroid injection followed by balloon dilatation or dilatation only. Randomisation and intervention will take place when a third dilatation is performed. The indication for dilatation will be confirmed with an oesophagram. One radiologist-blinded for randomisation-will review all oesophagrams. The primary outcome parameter is the total number of dilatations needed with <28 days' interval, which will be analysed with a linear-by-linear χ2 association test. Secondary outcome parameters include the level of dysphagia, the luminal oesophageal diameter and stricture length (measured on the oesophagrams), the influence of comedication on stricture formation, systemic effects of intralesional steroids (cortisol levels, length and weight) and the cost-effectiveness. Patients will undergo a second oesophagram; length and weight will be measured repeatedly; a scalp hair sample will be collected; and three questionnaires will be administered. The follow-up period will be 6 months, with evaluation at 2-3 weeks, 3 and 6 months after the intervention. ETHICS AND DISSEMINATION Patients will be included after written parental informed consent. The risks and burden associated with this trial are minimal. The institutional review board of the Erasmus Medical Centre approved this protocol (MEC-2018-1586/NL65364.078.18). The results of the trial will be published in a peer-reviewed scientific journal and will be presented at international conferences. TRIAL REGISTRATION NUMBERS 2018-002863-24 and NTR7726/NL7484.
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Affiliation(s)
- Chantal A Ten Kate
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - John Vlot
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Karel Allegaert
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marten J Poley
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Erica L T van den Akker
- Department of Paediatric Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rene M H Wijnen
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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27
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Zhou P, Wang YL, Liu Q, Li JS. Fallback technique with circular stapler prevents anastomotic obstruction after esophagectomy: A case report of surgical approach. Medicine (Baltimore) 2019; 98:e13571. [PMID: 30813121 PMCID: PMC6408128 DOI: 10.1097/md.0000000000013571] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE While performing esophago-ileal anastomosis after esophagectomy with circular staplers, the mucosal folds of the ileum can complicate stapling and lead to obstruction, especially when the diameter of the circular stapler is equal or greater than that of the small bowel lumen. PATIENT CONCERNS A 53-year-old man, presented with complaints of difficulty in swallowing for 2 weeks. Fifteen years previously, he had undergone partial gastrectomy for gastric ulcers. DIAGNOSIS The endoscopy showed that there was a large ulcer in the middle-third of the esophagus, about 28 to 32 cm from the incisors. Biopsy of the ulcer confirmed esophageal squamous cell carcinoma. INTERVENTIONS We performed an esophageal replacement using the right colon with circular staplers, but anastomotic site occurred due to stacking of the mucosa ahead of the stapler. To revise the anastomosis, we inserted the stapler 2 to 3 cm farther into the lumen than the intended site of anastomosis, and then pulled it back and rotated the stapler to complete the anastomosis. Consequently, the obstruction was corrected. OUTCOMES With nearly 16 months' follow-up duration until now, the patient has no difficulty swallowing and has twice received chemotherapy, and returned to his normal life relatively. LESSONS In the event of potential anastomotic obstruction due to accumulated mucosa, the stapler fallback technique can be successfully used achieve patent anastomosis.
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Affiliation(s)
| | - Ya-Li Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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28
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Kitagawa Y, Uno T, Oyama T, Kato K, Kato H, Kawakubo H, Kawamura O, Kusano M, Kuwano H, Takeuchi H, Toh Y, Doki Y, Naomoto Y, Nemoto K, Booka E, Matsubara H, Miyazaki T, Muto M, Yanagisawa A, Yoshida M. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1. Esophagus 2019; 16:1-24. [PMID: 30171413 PMCID: PMC6510883 DOI: 10.1007/s10388-018-0641-9] [Citation(s) in RCA: 345] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Takashi Uno
- Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsuneo Oyama
- Department of Gastroenterology, Saku Central Hospital, Nagano, Japan
| | - Ken Kato
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Kato
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Osamu Kawamura
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Motoyasu Kusano
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshio Naomoto
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University School of Medicine, Yonezawa, Japan
| | - Eisuke Booka
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuya Miyazaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Manabu Muto
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Akio Yanagisawa
- Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Chemotherapy Research Institute, International University of Health and Welfare, Ichikawa, Japan
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Steinbach EC, Hernandez M, Dellon ES. Eosinophilic Esophagitis and the Eosinophilic Gastrointestinal Diseases: Approach to Diagnosis and Management. J Allergy Clin Immunol Pract 2018; 6:1483-1495. [PMID: 30201096 PMCID: PMC6134874 DOI: 10.1016/j.jaip.2018.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/06/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022]
Abstract
The eosinophilic gastrointestinal diseases (EGIDs) represent disorders of the gastrointestinal (GI) tract that result from the local infiltration and aberrant activity of eosinophils and other immune cells. Eosinophilic esophagitis (EoE) is the most well-characterized EGID and is defined by the presence of intraepithelial eosinophils in the esophagus (≥15 eosinophils per high-powered field) and clinical symptoms associated with esophageal dysfunction. The other EGIDs are rare and lack strong data regarding pathogenesis and management. The incidence and prevalence of EoE are increasing, and EoE is now a major cause of upper GI morbidity. Management is multidisciplinary, with collaboration between gastroenterologists, allergists, pathologists, and dieticians, and is aimed at amelioration of symptoms and prevention of long-term complications such as esophageal stricture. Treatment options for EoE include proton pump inhibitors, swallowed topical corticosteroids, and elimination diets. Esophageal dilation is used when esophageal strictures or fibrostenotic changes are present. Additional therapies targeting eosinophils and other mediators of Th2 inflammation are under development and are promising. Treatment options for other EGIDs typically involve corticosteroids or dietary elimination.
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Affiliation(s)
- Erin C Steinbach
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Michelle Hernandez
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
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30
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Chai NL, Feng J, Li LS, Liu SZ, Du C, Zhang Q, Linghu EQ. Effect of polyglycolic acid sheet plus esophageal stent placement in preventing esophageal stricture after endoscopic submucosal dissection in patients with early-stage esophageal cancer: A randomized, controlled trial. World J Gastroenterol 2018; 24:1046-1055. [PMID: 29531468 PMCID: PMC5840469 DOI: 10.3748/wjg.v24.i9.1046] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/02/2018] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the effect of polyglycolic acid (PGA) plus stent placement compared with stent placement alone in the prevention of post-endoscopic submucosal dissection (ESD) esophageal stricture in early-stage esophageal cancer (EC) patients.
METHODS Seventy EC patients undergoing ESD were enrolled in this randomized, controlled study. Patients were allocated randomly at a 1:1 ratio into two groups as follows: (1) PGA plus stent group (PGA sheet-coated stent placement was performed); and (2) Stent group (only stent placement was performed). This study was registered on http://www.chictr.org.cn (No. chictr-inr-16008709).
RESULTS The occurrence rate of esophageal stricture in the PGA plus stent group was 20.5% (n = 7), which was lower than that in the stent group (46.9%, n = 15) (P = 0.024). The mean value of esophageal stricture time was 59.6 ± 16.1 d and 70.7 ± 28.6 d in the PGA plus stent group and stent group (P = 0.174), respectively. Times of balloon dilatation in the PGA plus stent group were less than those in the stent group [4 (2-5) vs 6 (1-14), P = 0.007]. The length (P = 0.080) and diameter (P = 0.061) of esophageal strictures were numerically decreased in the PGA plus stent group, whereas no difference in location (P = 0.232) between the two groups was found. Multivariate logistic analysis suggested that PGA plus stent placement (P = 0.026) was an independent predictive factor for a lower risk of esophageal stricture, while location in the middle third (P = 0.034) and circumferential range = 1/1 (P = 0.028) could independently predict a higher risk of esophageal stricture in EC patients after ESD.
CONCLUSION PGA plus stent placement is more effective in preventing post-ESD esophageal stricture compared with stent placement alone in EC patients with early-stage disease.
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Affiliation(s)
- Ning-Li Chai
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jia Feng
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Long-Song Li
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Sheng-Zhen Liu
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Chen Du
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi Zhang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| | - En-Qiang Linghu
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
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Abstract
In patients with eosinophilic esophagitis (EoE) who do not respond to proton pump inhibitors, initial anti-inflammatory/anti-eosinophilic treatment is with either topical corticosteroids or dietary elimination. A large body of literature supports the efficacy of these approaches, with histologic response rates in the 50-90% range for steroids and 70% range for the six-food elimination diet. However, these studies are almost all short-term and data evaluating long-term safety and efficacy of either treatment are limited. Nevertheless, because EoE is chronic, symptomatic, endoscopic, and histologic disease activity recurs when successful treatments are stopped. An emerging body of data also suggest that left untreated, persistent eosinophilic esophageal inflammation may progress to fibrostenosis over time. Therefore, maintenance therapy in EoE is intuitively attractive. This paper reviews the rationale for maintenance treatment in EoE, the available long-term pharmacologic and dietary response data for EoE, and discusses who may benefit the most from ongoing treatment. While all patients with EoE can be offered maintenance treatment, this option should be strongly recommended in patients with severe disease phenotypes or complications, including malnutrition or failure to thrive, esophageal fibrostenosis, strictures requiring dilation, recurrent food bolus impaction, history of perforation, and symptoms that recur quickly after treatment discontinuation. In all EoE patients, regular follow-up is also advised.
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Affiliation(s)
- Hamish Philpott
- Northern Adelaide Local Health Network (NALHN), Department of Gastroenterology Lyell McEwin and Modbury Hospitals, University of Adelaide, Adelaide, SA, Australia
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, CB#7080, Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC, 27599-7080, USA.
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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.
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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
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33
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Shi KD, Ji F. Prophylactic stenting for esophageal stricture prevention after endoscopic submucosal dissection. World J Gastroenterol 2017; 23:931-934. [PMID: 28246466 PMCID: PMC5311102 DOI: 10.3748/wjg.v23.i6.931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/06/2016] [Accepted: 11/13/2016] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) of superficial esophageal cancer has been increasingly used as an alternative to surgery because it is minimally invasive and has a high rate of en bloc resection. However, a high rate of esophageal stricture is observed after ESD for large lesions, which can dramatically decrease the patient’s quality of life. Stricture prevention is necessary to allow for endoscopic therapy to expand. We, herein, review the most recent evidence and discuss the role of the metallic self-expandable stent and the biodegradable stent in esophageal stricture prevention. Limited studies suggested that prophylactic stenting could reduce the stricture rate without increasing the number of complications. In addition, the number of bougie dilation procedures was significantly lower with stent placement. Esophageal stenting is a promising option for post-ESD stricture prevention. However, current evidence is too preliminary to formulate practice standards. Future studies are needed to further validate the efficacy and safety of prophylactic stenting and determine the best strategy for stricture prevention. Stent migration is the most common complication. A new stent that has advantages of a low migration rate and minimal tissue reaction will need to be developed. Therefore, randomized controlled trials with long-term follow-up periods are required before prophylactic stenting could be considered a valid option to prevent post-ESD stricture.
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Abstract
AIM OF THE STUDY Anastomotic strictures commonly occur in patients undergoing surgery for esophageal atresia (EA). The primary aim of this study was to determine the age distribution of dilation procedures for anastomotic strictures over the patient's childhood after reconstruction of EA. The secondary aim was to evaluate the effect of postoperative proton pump inhibitors (PPIs) on the frequency of dilations. METHODS This observational study was conducted at a single tertiary center of pediatric surgery. The times that dilations of strictures were performed were assessed during three study periods: 1983-1995, 2001-2009, and 2010-2014. PPIs were not used during the first period, and then, respectively, for 3 and 12 months postoperatively. The indications for dilation were signs of obstruction and/or radiological signs of stricture. PRIMARY RESULTS A total of 131 children underwent esophageal reconstruction, and of those, 60 (46%) required at least 1 dilation procedure for strictures. There were no differences in the frequencies of dilation procedures between the three study periods (28/66, 18/32 and 14/33, respectively; P = 0.42). The overall median number of dilations per patient was 3 (range 1-21) with no differences between the study periods. The differences between ages at which the first dilation was performed during each study period were significant, as follows: 7, 2, and 8 months, respectively (P = 0.03). Fiftyone percent of all dilation procedures were performed during the first year of life, 16% during the second year, and 33% during years 2-15. Four children (2%) underwent >12 dilations. CONCLUSION The first year of life was the time of greatest need for dilation of AS after reconstruction of EA; however, dilations were also performed several years later. PPIs did not affect the frequency of dilations during the first year of life.
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Affiliation(s)
- Pernilla Stenström
- Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Magnus Anderberg
- Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Anna Börjesson
- Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Einar Arnbjörnsson
- Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
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Ku Çu K A, Topaloglu N, Yildirim S, Tekin M, Erbas M, Kiraz HA, Erdem H, Özkan A. Protective effects of ursodeoxycholic acid in experimental corrosive esophagitis injury in rats. Ann Ital Chir 2017; 88:82-86. [PMID: 28447968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Accidental caustic ingestions are serious medical problems especially in childhood. Various treatment modalities are being used for the complications of caustic injuries such as stricture formation. The aim of this study is to establish whether ursodeoxycholic acid (UDCA) has protective effects on experimental corrosive esophagitis in rats. Twenty four Wistar-albino rats, weighing 220-240 g, were used in the study. Experimental animals were divided in three groups randomly: UDCA treatment group (Group T, n:8), control group (Group K, n: 8) and sham group (Group S, n: 8). In group T and S corrosive esophagitis was induced. UDCA (5 mg/kg) was performed to the group T for 10 days orally. All animals were sacrificed at the end of procedures and histopathological changes in esophageal tissue were scored by a single investigator who was blind to the groups. In group T inflammation was present in two rats, muscularis mucosa injury in two rats, grade 1 collagen deposition in six rats and grade 2 in two rats. In comparison with group S these were statistically significant (p value was 0.003, 0.003 and 0.015, respectively). UDCA has protective effect in experimental corrosive esophagitis. KEY WORDS Corrosive esophagitis, Rat, Stricture, Ursodeoxycholic acid.
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36
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Wen J, Lu Z, Linghu E, Yang Y, Yang J, Wang S, Yan B, Song J, Zhou X, Wang X, Meng K, Dou Y, Liu Q. Prevention of esophageal strictures after endoscopic submucosal dissection with the injection of botulinum toxin type A. Gastrointest Endosc 2016; 84:606-13. [PMID: 27032884 DOI: 10.1016/j.gie.2016.03.1484] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 01/25/2016] [Accepted: 03/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The use of endoscopic submucosal dissection (ESD) for management of widespread superficial esophageal squamous carcinoma is closely associated with esophageal stenosis. We investigated the efficacy and feasibility of endoscopic injection of botulinum toxin type A (BTX-A) for preventing esophageal strictures after ESD for superficial esophageal squamous carcinoma. METHODS Sixty-seven patients with superficial esophageal squamous cell carcinomas with mucosal defects that exceeded one half of the circumference of the esophagus after ESD treatment were enrolled and randomly divided into 2 groups (group A, n = 33; group B, n = 34). Patients in group A (BTX-A group) were immediately injected with BTX-A after ESD, whereas patients in group B (control group) received ESD only. Endoscopy was performed when patients reported dysphagia symptoms and at 12 weeks post-ESD in patients without symptoms. Patients who experienced post-ESD esophageal strictures in both groups received bougie dilation. RESULTS The number of patients who experienced esophageal strictures in group A (per protocol analysis, 6.1%, 2/33; intention to treat analysis, 11.4%, 4/35) was significantly less than that seen in group B (per protocol analysis, 32.4%, 11/34; intention to treat analysis, 37.8%, 14/37) (P < .05). Moreover, the number of bougie dilation procedures was significantly lower in group A (mean, 1.5; range, 0-2) than in group B (mean, 2.8; range, 0-5) (P < .05). CONCLUSIONS Endoscopic injection of BTX-A was effective in preventing post-ESD esophageal strictures and decreasing the times of bougie dilation procedures. ( CLINICAL TRIAL REGISTRATION NUMBER ChiCTR-TRC-12003188.).
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Affiliation(s)
- Jing Wen
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China; Department of Gastroenterology and Hepatology, Chinese PLA 261 Hospital, Beijing, China
| | - Zhongsheng Lu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Jing Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Shufang Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Bin Yan
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Jie Song
- Department of Gastroenterology and Hepatology, Chinese PLA 261 Hospital, Beijing, China
| | - Xiaodong Zhou
- Department of Gastroenterology and Hepatology, Chinese PLA 261 Hospital, Beijing, China
| | - Xiangdong Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Ke Meng
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Yan Dou
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Qingsen Liu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
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37
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Ormeño Julca AJ. [Use of corticosteroids in esophagitis caustic ingestion. Report of two cases]. Rev Gastroenterol Peru 2016; 36:256-259. [PMID: 27716764] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Exposure to potentially toxic substances represents 0.3% of annual visits to a pediatric emergency department, being a situation likely to be prevented and that generates a non-negligible morbidity and mortality. The most common route of exposure is the oral and drugs are the products most frequently involved. Esophagitis caustic ingestion of corrosive substances in childhood is now a public health problem in developing countries. Clinical manifestations vary from no injuries serious commitment to high risk of death observed more frequently in patients between one and three years old. In addition to drilling, the most severe complication of esophagitis is caustic stricture formation, which occurs at a frequency of 5% to 47% in severe cases. The role of systemic corticosteroids in preventing caustic esophageal stenosis is still considered controversial, despite the many published reports showing your benefit. We report two cases of pediatric patients with caustic esophagitis IIB Zargar who received systemic corticosteroids with favorable evolution.
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Affiliation(s)
- Alexis José Ormeño Julca
- área de Hospitalización, Servicio de Pediatría del Hospital Regional de Lambayeque. Lambayeque, Perú
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38
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Wakahara C, Morita Y, Tanaka S, Hoshi N, Kawara F, Kibi M, Ishida T, Man-I M, Fujita T, Toyonaga T. Optimization of steroid injection intervals for prevention of stricture after esophageal endoscopic submucosal dissection: A randomized controlled trial. Acta Gastroenterol Belg 2016; 79:315-320. [PMID: 27821027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Esophageal endoscopic submucosal dissection enables en bloc resection of large superficial esophageal cancer; however, this procedure may induce severe stricture. Intralesional steroid injection is an effective treatment for prevention of stricture after endoscopic resection; however, there have been no studies assessing the duration of such treatment. The aim of this study was to reduce treatment duration and to evaluate the effectiveness of weekly and biweekly steroid injections in preventing esophageal stricture after endoscopic resection. PATIENTS METHOD We performed a randomized controlled trial comparing patients receiving weekly or biweekly intralesional triamcinolone injections. Patients with a mucosal defect greater than 75% (3/4) of the luminal circumference after esophageal endoscopic submucosal dissection for superficial esophageal cancers were enrolled. The primary endpoint was the duration of steroid injection treatment. RESULTS The median duration of treatment was 37.0 days in the weekly group and 34.2 days in the biweekly group (P = 0.059). Among patients with a mucosal defect larger than 50 mm, there was a significant difference in the median duration of treatment between the weekly and biweekly groups (42.5 days vs 29.0 days, P = 0.013). CONCLUSION Biweekly steroid injection of triamcinolone reduces treatment duration, particularly in those with mucosal defects larger than 50 mm. (Acta gastro-enterol. belg., 2016, 79, 315-320).
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Perrod G, Rahmi G, Pidial L, Camilleri S, Bellucci A, Casanova A, Viel T, Tavitian B, Cellier C, Clement O. Cell Sheet Transplantation for Esophageal Stricture Prevention after Endoscopic Submucosal Dissection in a Porcine Model. PLoS One 2016; 11:e0148249. [PMID: 26930409 PMCID: PMC4773126 DOI: 10.1371/journal.pone.0148249] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 01/16/2016] [Indexed: 12/25/2022] Open
Abstract
Background & Aims Extended esophageal endoscopic submucosal dissection (ESD) is highly responsible for esophageal stricture. We conducted a comparative study in a porcine model to evaluate the effectiveness of adipose tissue-derived stromal cell (ADSC) double cell sheet transplantation. Methods Twelve female pigs were treated with 5 cm long hemi-circumferential ESD and randomized in two groups. ADSC group (n = 6) received 4 double cell sheets of allogenic ADSC on a paper support membrane and control group (n = 6) received 4 paper support membranes. ADSC were labelled with PKH-67 fluorophore to allow probe-based confocal laser endomicroscopie (pCLE) monitoring. After 28 days follow-up, animals were sacrificed. At days 3, 14 and 28, endoscopic evaluation with pCLE and esophagography were performed. Results One animal from the control group was excluded (anesthetic complication). Animals from ADSC group showed less frequent alimentary trouble (17% vs 80%; P = 0.08) and higher gain weight on day 28. pCLE demonstrated a compatible cell signal in 4 animals of the ADSC group at day 3. In ADSC group, endoscopy showed that 1 out of 6(17%) animals developed a severe esophageal stricture comparatively to 100% (5/5) in the control group; P = 0.015. Esophagography demonstrated a decreased degree of stricture in the ADSC group on day 14 (44% vs 81%; P = 0.017) and day 28 (46% vs 90%; P = 0.035). Histological analysis showed a decreased fibrosis development in the ADSC group, in terms of surface (9.7 vs 26.1 mm²; P = 0.017) and maximal depth (1.6 vs 3.2 mm; P = 0.052). Conclusion In this model, transplantation of allogenic ADSC organized in double cell sheets after extended esophegeal ESD is strongly associated with a lower esophageal stricture’s rate.
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Affiliation(s)
- Guillaume Perrod
- Université Paris Descartes Sorbonne Paris cité, Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris Descartes Sorbonne Paris cité, Laboratoire imagerie de l’angiogenèse et plateforme d’imagerie du petit animal, UMR-S970, 56 rue Leblanc, 75015 Paris, France
- Université Paris Descartes Sorbonne Paris cité, Laboratory of biosurgical research, UMR-U633, 56 rue Leblanc, 75015 Paris, France
| | - Gabriel Rahmi
- Université Paris Descartes Sorbonne Paris cité, Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris Descartes Sorbonne Paris cité, Laboratoire imagerie de l’angiogenèse et plateforme d’imagerie du petit animal, UMR-S970, 56 rue Leblanc, 75015 Paris, France
- Université Paris Descartes Sorbonne Paris cité, Laboratory of biosurgical research, UMR-U633, 56 rue Leblanc, 75015 Paris, France
- * E-mail:
| | - Laetitia Pidial
- Université Paris Descartes Sorbonne Paris cité, Laboratoire imagerie de l’angiogenèse et plateforme d’imagerie du petit animal, UMR-S970, 56 rue Leblanc, 75015 Paris, France
| | - Sophie Camilleri
- Université Paris Descartes Sorbonne Paris cité, Assistance Publique-Hôpitaux de Paris, Department of Pathology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Alexandre Bellucci
- Université Paris Descartes Sorbonne Paris cité, Laboratoire imagerie de l’angiogenèse et plateforme d’imagerie du petit animal, UMR-S970, 56 rue Leblanc, 75015 Paris, France
- Université Paris Descartes Sorbonne Paris cité Assistance Publique-Hôpitaux de Paris, Department of Radiology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Amaury Casanova
- Université Paris Descartes Sorbonne Paris cité, Laboratoire imagerie de l’angiogenèse et plateforme d’imagerie du petit animal, UMR-S970, 56 rue Leblanc, 75015 Paris, France
| | - Thomas Viel
- Université Paris Descartes Sorbonne Paris cité, Laboratoire imagerie de l’angiogenèse et plateforme d’imagerie du petit animal, UMR-S970, 56 rue Leblanc, 75015 Paris, France
| | - Bertrand Tavitian
- Université Paris Descartes Sorbonne Paris cité, Laboratoire imagerie de l’angiogenèse et plateforme d’imagerie du petit animal, UMR-S970, 56 rue Leblanc, 75015 Paris, France
- Université Paris Descartes Sorbonne Paris cité Assistance Publique-Hôpitaux de Paris, Department of Radiology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Christophe Cellier
- Université Paris Descartes Sorbonne Paris cité, Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Olivier Clement
- Université Paris Descartes Sorbonne Paris cité, Laboratoire imagerie de l’angiogenèse et plateforme d’imagerie du petit animal, UMR-S970, 56 rue Leblanc, 75015 Paris, France
- Université Paris Descartes Sorbonne Paris cité Assistance Publique-Hôpitaux de Paris, Department of Radiology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
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Zhai YQ, Li HK, Linghu EQ. Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms. World J Gastroenterol 2016; 22:435-445. [PMID: 26755889 PMCID: PMC4698506 DOI: 10.3748/wjg.v22.i1.435] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/30/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is a well-established treatment for superficial esophageal squamous cell neoplasms (SESCNs) with no risk of lymphatic metastasis. However, for large SESCNs, especially when exceeding two-thirds of the esophageal circumference, conventional ESD is time-consuming and has an increased risk of adverse events. Based on the submucosal tunnel conception, endoscopic submucosal tunnel dissection (ESTD) was first introduced by us to remove large SESCNs, with excellent results. Studies from different centers also reported favorable results. Compared with conventional ESD, ESTD has a more rapid dissection speed and R0 resection rate. Currently in China, ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique, as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis propria. However, not all patients with SESCNs are candidates for ESTD, and postoperative esophageal strictures should also be taken into consideration, especially for lesions with a circumference greater than three-quarters. In this article, we describe our experience, review the literature of ESTD, and provide detailed information on indications, standard procedures, outcomes, and complications of ESTD.
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Sun HB, Li Y, Liu XB, Zhang RX, Wang ZF, Zheng Y, Qin JJ, Li HM, Chen XK, Wu Z. Embedded Three-Layer Esophagogastric Anastomosis Reduces Morbidity and Improves Short-Term Outcomes After Esophagectomy for Cancer. Ann Thorac Surg 2015; 101:1131-8. [PMID: 26687140 DOI: 10.1016/j.athoracsur.2015.09.094] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 06/29/2015] [Revised: 08/24/2015] [Accepted: 09/28/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND There exists great controversy regarding the use of esophagogastric anastomotic techniques in the treatment of esophageal cancer. The aim of this study was to compare two types of cervical esophagogastric anastomoses with respect to the reduction of postoperative anastomotic leaks, stenosis, and gastroesophageal reflux. METHODS From June 2010 to September 2013, 339 patients who underwent two different cervical esophagogastric anastomotic procedures after thoracolaparoscopic esophagectomy for esophageal cancer were identified. RESULTS A total of 166 patients with esophageal cancer were treated using an embedded three-layer anastomosis (embedded group), and 173 were treated using a conventional two-layer anastomosis (conventional group). The rates of anastomotic leak (2.4% [4 of 166] versus 7.5% [13 of 173], p = 0.031) and benign anastomotic stricture (4.8% [8 of 166] versus 12.7% [22 of 173], p = 0.010) were significantly lower in the embedded group compared with the conventional group. The mean reflux scores were significantly higher among the patients in the conventional group compared with the patients in the embedded group at 1 month (25.2 versus 19.0, p = 0.001), 3 months (27.8 versus 21.4, p = 0.001), and 6 months (23.4 versus 17.8, p < 0.001) of follow-up. The mean scores for dysphagia were significantly lower among the patients in the embedded group compared with the patients in the conventional group at both 3 months (22.7 versus 29.8, p = 0.012) and 6 months (16.0 versus 21.3, p = 0.008) of follow-up. CONCLUSIONS The new embedded three-layer esophagogastric anastomosis offers several advantages and reduces the incidence of postoperative complications such as anastomotic leak, stricture, and gastroesophageal reflux.
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Affiliation(s)
- Hai-Bo Sun
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Xian-Ben Liu
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Rui-Xiang Zhang
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zong-Fei Wang
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yan Zheng
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jian-Jun Qin
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hao-Miao Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xian-Kai Chen
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhao Wu
- Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Abstract
Esophageal stricture is a severe adverse event after circumferential endoscopic submucosal dissection (ESD). Steroid administration is a new method to prevent stricture formation. We performed a meta-analysis to investigate the efficacy and safety of steroid administration to prevent esophageal stricture after circumferential ESD. PubMed, the Cochrane Library, EMBASE, Chinese Biomedical Database, and Clinicaltrials.gov were searched. Studies on steroid administration + endoscopic balloon dilation (EBD) versus EBD alone for esophageal stricture were included and pooled analyzed in random-effects models. Besides, subgroup analysis and network analysis were performed to define the influence of ESD type and steroid administration method. Twelve studies involving 513 patients were included. Meta-analysis showed that steroid administration significantly achieved a lower stricture rate (risk ratio [RR], 0.40; 95% CI, 0.20-0.81) and less required EBD sessions (mean difference [MD], -4.33; 95% CI, -6.10 to -2.57) than control. Subgroup analysis indicated that steroid was effective after both semi- and complete circumferential ESD. Network meta-analysis showed that compared with oral steroid, local injected steroid had a similar effect to prevent stricture (RR, 1.16; 95% CI, 0.48-2.85), whereas a better effect to reduce required EBD sessions (MD, 7.77; 95%CI, 0.26-15.3). Additional steroid administration is effective to reduce the stricture rate and required EBD sessions. And local injected steroid was superior to oral steroid in EBD reduction, whereas due to the varied method and dose of steroid administration, the finding needs to be clarified in the future.
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Affiliation(s)
- Wenjin Wang
- From the Department of Emergency, The First Hospital of Lanzhou University, Lanzhou, China (WWJ); Department of Geriatric Medicine, The First Hospital of Lanzhou University, Lanzhou, China (MZY); and Center of Evidence-based Medicine, Lanzhou University First Hospital, Lanzhou, China (MZY)
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Uno K, Iijima K, Koike T, Shimosegawa T. Useful strategies to prevent severe stricture after endoscopic submucosal dissection for superficial esophageal neoplasm. World J Gastroenterol 2015; 21:7120-7133. [PMID: 26109798 PMCID: PMC4476873 DOI: 10.3748/wjg.v21.i23.7120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/24/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023] Open
Abstract
The minimal invasiveness of endoscopic submucosal dissection (ESD) prompted us to apply this technique to large-size early esophageal squamous cell carcinoma and Barrett’s adenocarcinoma, despite the limitations in the study population and surveillance duration. A post-ESD ulceration of greater than three-fourths of esophageal circumference was advocated as an important risk factor for refractory strictures that require several sessions of dilation therapy. Most of the preoperative conditions are asymptomatic, but dilatation treatment for dysphagia associated with the stricture has potential risks of severe complications and a worsening of quality of life. Possible mechanisms of dysphasia were demonstrated based on dysmotility and pathological abnormalities at the site: (1) delayed mucosal healing; (2) severe inflammation and disorganized fibrosis with abundant extracellular matrices in the submucosa; and (3) atrophy in the muscularis proper. However, reports on the administration of anti-scarring agents, preventive dilation therapies, and regenerative medicine demonstrated limited success in stricture prevention, and there were discrepancies in the study designs and protocols of these reports. The development and consequent long-term assessments of new prophylactic technologies on the promotion of wound healing and control of the inflammatory/tumor microenvironment will require collaboration among various research fields because of the limited accuracy of preoperative staging and high-risk of local recurrence.
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Takahashi H, Arimura Y, Okahara S, Kodaira J, Hokari K, Tsukagoshi H, Shinomura Y, Hosokawa M. A randomized controlled trial of endoscopic steroid injection for prophylaxis of esophageal stenoses after extensive endoscopic submucosal dissection. BMC Gastroenterol 2015; 15:1. [PMID: 25609176 PMCID: PMC4308850 DOI: 10.1186/s12876-014-0226-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/27/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Esophageal stenosis following endoscopic submucosal dissection (ESD) is a serious adverse event that makes subsequent management more difficult. METHODS This parallel, randomized, controlled, open-label study was designed to examine whether local steroid injection is an effective prophylactic treatment for esophageal stenoses following extensive ESD. This single center trial was conducted at the Keiyukai Hospital, a tertiary care center for gastrointestinal disease in Japan [University Hospital Medical Network Clinical Trial Registry (UMIN-CTR) on 15 September 2011 (UMIN000006327)]. Thirty-two patients with mucosal defects involving ≥75% of the esophageal circumference were randomized to receive a single dose of triamcinolone acetonide injections (n = 16) or be treated conventionally (n = 16). The primary outcome was the frequency of stricture requiring endoscopic dilatation; the surrogate primary endpoint was the number of dilatation sessions needed. Secondary outcomes included adverse event rates, the minimum diameter of the stenotic area and the duration of the course of dilatation treatments. RESULTS The frequency of stricture was not significantly different between the groups because of insufficient statistical power, but the number of dilatation sessions required was significantly less in the steroid group (6.1 sessions [95% confidence interval, CI 2.8-9.4] versus 12.5 [95% CI 7.1-17.9] sessions in the control group; P = 0.04). The perforation rate was similar in both groups. The minimum diameter of stenotic lumens was significantly greater in the treatment group than controls (11.0 mm versus 7.1 mm, respectively; P = 0.01). The perforation rate was not significantly different between the groups (1.0% versus 0.5% in the treatment and control group, respectively). Steroid injection was effective in cases of mucosal defects encompassing the entire esophageal circumference. CONCLUSIONS Prophylactic endoscopic steroid injection appears to be a safe means of relieving the severity of esophageal stenoses following extensive ESD.
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Affiliation(s)
- Hiroaki Takahashi
- Department of Gastroenterology, Keiyukai Daini Hospital, Hondori-13, Shiroishi-ku, Sapporo, 003-0027, Japan.
| | - Yoshiaki Arimura
- Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Satoshi Okahara
- Department of Gastroenterology, Keiyukai Daini Hospital, Hondori-13, Shiroishi-ku, Sapporo, 003-0027, Japan.
| | - Junichi Kodaira
- Department of Gastroenterology, Keiyukai Daini Hospital, Hondori-13, Shiroishi-ku, Sapporo, 003-0027, Japan.
| | - Kaku Hokari
- Department of Gastroenterology, Keiyukai Sapporo Hospital, Hondori-14, Shiroishi-ku, Sapporo, 003-0027, Japan.
| | - Hiroyuki Tsukagoshi
- Department of Gastroenterology, Keiyukai Sapporo Hospital, Hondori-14, Shiroishi-ku, Sapporo, 003-0027, Japan.
| | - Yasuhisa Shinomura
- Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Masao Hosokawa
- Department of Surgery, Keiyukai Sapporo Hospital, Hondori-14, Shiroishi-ku, Sapporo, 003-0027, Japan.
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Dai JG, Liu QX, Den XF, Min JX. Oesophageal flap valvuloplasty and wrapping suturing prevent gastrooesophageal reflux disease in dogs after oesophageal anastomosis. World J Gastroenterol 2014; 20:17434-17438. [PMID: 25516655 PMCID: PMC4265602 DOI: 10.3748/wjg.v20.i46.17434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/16/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the efficiency of oesophageal flap valvuloplasty and wrapping suturing technique in decreasing the rate of postoperative gastrooesophageal reflux disease in a dog model.
METHODS: We operated on 10 dogs in this study. First, we resected a 5-cm portion of the distal oesophagus and then restored the continuity of the oesophageal and gastric walls by end-to-end anastomosis. A group of five dogs was subjected to the oesophageal flap valvuloplasty and wrapping suturing technique, whereas another group (control) of five dogs was subjected to the stapling technique after oesophagectomy. The symptom of gastrooesophageal reflux was recorded by 24-h pH oesophageal monitoring. Endoscopy and barium swallow examination were performed on all dogs. Anastomotic leakage was observed by X-ray imaging, whereas benign anastomotic stricture and mucosal damage were observed by endoscopy.
RESULTS: None of the 10 dogs experienced anastomotic leakage after oesophagectomy. Four dogs in the new technology group resumed regular feeding, whereas only two of the dogs in the control group tolerated solid food intake. pH monitoring demonstrated that 25% of the dogs in the experimental group exhibited reflux and that none had mucosal damage consistent with reflux. Conversely, both reflux and mucosal damage were observed in all dogs in the control group.
CONCLUSION: The oesophageal flap valvuloplasty and wrapping suturing technique can improve the postoperative quality of life through the long-term elimination of reflux oesophagitis and decreased stricture formation after primary oesophageal anastomosis.
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Kobayashi S, Kanai N, Ohki T, Takagi R, Yamaguchi N, Isomoto H, Kasai Y, Hosoi T, Nakao K, Eguchi S, Yamamoto M, Yamato M, Okano T. Prevention of esophageal strictures after endoscopic submucosal dissection. World J Gastroenterol 2014; 20:15098-15109. [PMID: 25386058 PMCID: PMC4223243 DOI: 10.3748/wjg.v20.i41.15098] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/14/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have recently been accepted as less invasive methods for treating patients with early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett’s esophagus. However, the large defects in the esophageal mucosa often cause severe esophageal strictures, which dramatically reduce the patient’s quality of life. Although preventive endoscopic balloon dilatation can reduce dysphagia and the frequency of dilatation, other approaches are necessary to prevent esophageal strictures after ESD. This review describes several strategies for preventing esophageal strictures after ESD, with a particular focus on anti-inflammatory and tissue engineering approaches. The local injection of triamcinolone acetonide and other systemic steroid therapies are frequently used to prevent esophageal strictures after ESD. Tissue engineering approaches for preventing esophageal strictures have recently been applied in basic research studies. Scaffolds with temporary stents have been applied in five cases, and this technique has been shown to be safe and is anticipated to prevent esophageal strictures. Fabricated autologous oral mucosal epithelial cell sheets to cover the defective mucosa similarly to how commercially available skin products fabricated from epidermal cells are used for skin defects or in cases of intractable ulcers. Fabricated autologous oral-mucosal-epithelial cell sheets have already been shown to be safe.
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Yano T, Odagaki T, Morimoto H, Yoda Y, Oono Y, Kaneko K. [Up to date of ESD for esophageal cancer]. Nihon Shokakibyo Gakkai Zasshi 2013; 110:1731-1737. [PMID: 24097144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Tomonori Yano
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East
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48
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Abstract
In children, caustic ingestion is due to accidents at home and inadequate storage of caustic agents. In emergency, it is useful to remove the soiled clothes, rinse the affected area, and prevent vomiting and feeding. Caustic ingestion (pH<2 or>12) induces burns of the upper gastrointestinal tract requiring esophagogastro-duodenoscopy between H12 and H24. Strong alkalis cause necrosis with liquefaction of the esophagus, penetrating deeply with a high-risk of perforation. Management of these children requires a specialized care center with an intensive care unit, endoscopic equipment, and a surgical team. Esophageal stricture is the main complication; no prophylactic treatment (steroids) is effective. Strictures occur after the 3rd week, and barium swallow should be performed by the end of the 1st month. Stricture are often multiple, long, and tortuous; endoscopic dilatation is difficult with a high-rate of perforation and a low-rate of success. In situ application of mitomycin C or injection of triamcinolone could reduce the recurrence rate of stricture. In recalcitrant or recurrent strictures, it is recommended to perform an esophageal replacement using a colonic interposition or a gastric tube. Endoscopy should also be performed 15-20years after caustic ingestion to screen for early neoplastic lesions. Prevention is very important for avoiding caustic ingestions. Information and education should be given specifically to the parents of toddlers; caustic products should be stored out of reach of children and they should not be kept with food.
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Affiliation(s)
- E Mas
- Unité de gastroentérologie, hépatologie, nutrition et diabétologie, hôpital des Enfants, 330, avenue de Grande-Bretagne, TSA 70034, 31300 Toulouse cedex 9, France.
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Pauli EM, Schomisch SJ, Furlan JP, Marks AS, Chak A, Lash RH, Ponsky JL, Marks JM. Biodegradable esophageal stent placement does not prevent high-grade stricture formation after circumferential mucosal resection in a porcine model. Surg Endosc 2012; 26:3500-8. [PMID: 22684976 PMCID: PMC4562670 DOI: 10.1007/s00464-012-2373-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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: 02/28/2012] [Accepted: 05/02/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Advanced esophageal dysplasia and early cancers have been treated traditionally with esophagectomy. Endoscopic esophageal mucosectomy (EEM) offers less-invasive therapy, but high-degree stricture formation limits its applicability. We hypothesized that placement of a biodegradable stent (BD-stent) immediately after circumferential EEM would prevent stricturing. METHODS Ten pigs (five unstented controls, five BD-stent) were utilized. Under anesthesia, a flexible endoscope with a band ligator and snare was used to incise the mucosa approximately 20 cm proximal to the lower esophageal sphincter. A 10-cm, circumferential, mucosal segment was dissected and excised by using snare electrocautery. In the stented group, an 18-×120-mm, self-expanding, woven polydioxanone stent (ELLA-CS, Hradec-Kralove) was deployed. Weekly esophagograms evaluated for percent reduction in esophageal diameter, stricture length, and proximal esophageal dilation. Animals were euthanized when the stricture exceeded 80% and were unable to gain weight (despite high-calorie liquid diet) or at 14 weeks. RESULTS The control group rapidly developed esophageal strictures; no animal survived beyond the third week of evaluation. At 2 weeks post-EEM, the BD-stent group had a significant reduction in esophageal diameter (77.7 vs. 26.6%, p < 0.001) and degree of proximal dilation (175 vs. 131%, p = 0.04) compared with controls. Survival in the BD-stent group was significantly longer than in the control group (9.2 vs. 2.4 weeks, p = 0.01). However, all BD-stent animals ultimately developed clinically significant strictures (range, 4-14 weeks). Comparison between the maximum reduction in esophageal diameter and stricture length (immediately before euthanasia) demonstrated no differences between the groups. CONCLUSIONS Circumferential EEM results in severe stricture formation and clinical deterioration within 3 weeks. BD-stent placement significantly delays the time of clinical deterioration from 2.4 to 9.2 weeks, but does not affect the maximum reduction in esophageal diameter or proximal esophageal dilatation. The timing of stricture formation in the BD-stent group correlated with the loss radial force and stent disintegration.
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Affiliation(s)
- Eric M. Pauli
- Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Mail Stop LKS 5047, Cleveland, OH 44106, USA
| | - Steve J. Schomisch
- Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Mail Stop LKS 5047, Cleveland, OH 44106, USA
| | - Joseph P. Furlan
- Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Mail Stop LKS 5047, Cleveland, OH 44106, USA
| | - Andrea S. Marks
- Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Mail Stop LKS 5047, Cleveland, OH 44106, USA
| | - Amitabh Chak
- Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA
| | - Richard H. Lash
- Miraca Life Sciences Research Institute, Irving, TX 75039, USA
| | - Jeffrey L. Ponsky
- Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Mail Stop LKS 5047, Cleveland, OH 44106, USA
| | - Jeffrey M. Marks
- Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Mail Stop LKS 5047, Cleveland, OH 44106, USA
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Qian LJ, Yu LZ, Wang B, Ding J, Chen L, Xu SF, Zhao J, Shi RH. [Prevention of restenosis with a new modified fully-covered retrievable esophageal stent]. Zhonghua Yi Xue Za Zhi 2012; 92:3108-3112. [PMID: 23328419] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To observe and evaluate the effectiveness of a new modified fully-covered retrievable esophageal stent in preventing restenosis at the proximal end of the stent. METHODS From January 2008 to October 2011, 380 consecutive patients who underwent placement of a conventional stent or a new modified stent for benign or malignant dysphagia were divided into two groups: conventional stent group 193 patients (male 137, female 56) and modified stent group 187 patients (male 125, female 62). The granulation formation and restenosis rate one month after stenting were evaluated. Data such as patient demographics, outcomes and complications were collected. The results were statistically analyzed by Student t test, chi-squared test, Fisher's exact probability or rank sum test. A P-value less than 0.05 was considered statistically significant. RESULTS All stents were successfully implanted. They were highly effective in palliating dysphagia. The dysphagia score decreased from 3 (1) to 0 (1) in conventional stent group (P < 0.01), and that from 4 (1) to 0 (1) in modified stent group (P < 0.01). The modified stent group were superior to the conventional stent group in severe granulation formation rate (0 vs 4.7% (9/193), P = 0.004) and restenosis rate (2.7% (5/187) vs 7.3% (14/193), P = 0.041) within one month after stenting, and the modified stent was easier to retrieve. Postoperative remission rate of dysphagia, and complications such as chest pain, bleeding, perforation, stent migration had no statistical differences between the two groups (all P > 0.05). CONCLUSIONS The new modified fully-covered retrievable esophageal stent can significantly reduce granulation formation at the proximal end of the stent. Using of this stent seems to be a better choice in treating patient of dysphagia, with lower restenosis rate and easier to retrieve.
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Affiliation(s)
- Li-juan Qian
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, China
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