title: Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) permits removal of esophageal epithelial neoplasms en bloc, but is associated with esophageal stenosis, particularly when ESD involves the entire circumference of the esophageal lumen. We examined the effectiveness of systemic steroid administration for control of postprocedural esophageal stricture after complete circular ESD.
  
  
  METHODS
  Seven patients who underwent wholly circumferential ESD for superficially extended esophageal squamous cell carcinoma were enrolled in this study. In 3 patients, prophylactic endoscopic balloon dilatation (EBD) was started on the third post-ESD day and was performed twice a week for 8 weeks. In 4 patients, oral prednisolone was started with 30 mg daily on the third post-ESD day, tapered gradually (daily 30, 30, 25, 25, 20, 15, 10, 5 mg for 7 days each), and then discontinued at 8 weeks. EBD was used as needed whenever patients complained of dysphagia.
  
  
  RESULTS
  En bloc ESD with tumor-free margins was safely achieved in all cases. Patients in the prophylactic EBD group required a mean of 32.7 EBD sessions; the postprocedural stricture was dilated up to 18 mm in diameter in these patients. On the other hand, systemic steroid administration substantially reduced or eliminated the need for EBD. Corticosteroid therapy was not associated with any adverse events. Post-ESD esophageal stricture after complete circular ESD was persistent, requiring multiple EBD sessions.
  
  
  CONCLUSIONS
  Use of oral prednisolone administration may be an effective treatment strategy for reducing post-ESD esophageal stricture after complete circular ESD.
authors.affiliation: Department of Endoscopy, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan. hajimei2002@yahoo.co.jp
authors.forename: Hajime
authors.initials: H
authors.lastname: Isomoto
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yamaguchi
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakayama
authors.forename: Tomayoshi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nishiyama
authors.forename: Ken
authors.initials: K
authors.lastname: Ohnita
authors.forename: Fuminao
authors.initials: F
authors.lastname: Takeshima
authors.forename: Saburo
authors.initials: S
authors.lastname: Shikuwa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakao
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002404:Catheterization; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D011239:Prednisolone / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone