Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection.
OBJECTIVE
We earlier reported that mucosal defect involving over three-fourths of the circumference of the esophagus after endoscopic mucosal resection (EMR) is a risk factor for the development of the stricture. Although endoscopic balloon dilation (EBD) is a useful procedure to relieve the stricture, there is no standard strategy for preventing development of the stricture. The aim of this study was to evaluate the efficacy and the safety of preventive EBD.


METHODS
From 1993 to 2008, 41 consecutive patients with extensive mucosal defect involving over three-fourths of the esophageal circumference after EMR or endoscopic submucosal dissection (ESD) were investigated. Preventive EBD was carried out for 29 cases within 1 week just after EMR/ESD and was repeated once a week until the mucosal defect was completely healed. The remaining 12 cases were not underwent preventive EBD and used as a historic control. If postEMR/ESD stricture developed regardless of preventive EBD, conventional EBD was given repeatedly until the stricture was completely relieved.


RESULTS
Preventive EBD decreased the incidence of stricture (59% vs. 92%, P =0.04), reduced the severity of stricture [(≤2 mm; >2 mm and ≤5 mm; >5 mm)=(1; 2; 14) vs. (4; 4; 3), P = 0.01] and shortened the duration required for resolving the stricture (29 d vs. 78 d, P =0.04) even when stricture developed. There was no complication associated with preventive EBD procedure.


CONCLUSIONS
Preventive EBD is an effective procedure to prevent postEMR/ESD stricture. Preventive EBD should be considered when EMR/ESD results in a mucosal defect with a circumference greater than three-fourths of the esophageal lumen.
Ezoe
Yasumasa
Y
Department of Multidisciplinary Cancer Treatment, Kyoto University, Kyoto, Japan. yasuzoe@kuhp.kyoto-u.ac.jp
Muto
Manabu
M
Horimatsu
Takahiro
T
Morita
Shuko
S
Miyamoto
Shin'ichi
S
Mochizuki
Satoshi
S
Minashi
Keiko
K
Yano
Tomonori
T
Ohtsu
Atsushi
A
Chiba
Tsutomu
T
D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000601:surgery; D004940:Esophageal Stenosis / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D004945:Esophagoscopy / Q000009:adverse effects* / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome