Preemptive dilatation gives good outcome to early esophageal stricture after circumferential endoscopic submucosal dissection.
Endoscopic submucosal dissection (ESD) is gaining popularity over endoscopic mucosal resection for treatment of superficial upper gastrointestinal cancers. It allows a more controlled en-bloc resection of intramucosal neoplasia allowing larger lesion in both stomach and esophagus to be resected. Lower local recurrence rate can be achieved. This is particularly important in the esophagus, as luminal stricture and deep fibrosis often hinder the possibility of repeat endoscopic resection of recurrences. The exact incidence of benign luminal strictures after the ESD of the esophagus lesion is unknown, but the risk is related to the circumferential extent of the lesion being resected, which is expected to develop in cases with post-ESD ulcer more than two-thirds of the circumference. We report 2 patients with early stenosis after circumferential ESD. We have also showed that scheduled early regular endoscopic balloon dilatation was effective in controlling and preventing post-ESD stricture. In conclusion, we suggest early follow-up esophagogastroduodenoscopy to be done for patients with circumferential ESD to determine the need of preemptive dilatation.
Wong
Vivien Wai-yin
VW
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China. vivienwong@surgery.cuhk.edu.hk
Teoh
Anthony Y
AY
Fujishiro
Mitsuhiro
M
Chiu
Philip W
PW
Ng
Enders K W
EK
D000368:Aged; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000517:prevention & control*; D004945:Esophagoscopy / Q000379:methods*; D017809:Fatal Outcome; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome