Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity.
OBJECTIVE
Endoscopic submucosal dissection (ESD) of large gastric lesions results in an extensive artificial ulcer that can lead to marked gastric deformity. The aim of the current study was to evaluate therapeutic efficacy in the prevention of gastric deformity of local triamcinolone acetonide (TCA) injection into the extensive artificial ulcer following ESD.


METHODS
A total of 45 patients who were diagnosed with early gastric cancer were enrolled. Patients were randomly assigned by the sealed-envelope randomization method to either local TCA injections (n = 21) or sham-control (n = 20) groups. Two clips were placed at the two maximum outer edges of the artificial ulcer after the lesion had been resected (Day 0). Local TCA injections were performed on postoperative Day 5 and Day 12. The distance between the two clips was measured by endoscopic measuring forceps on Days 5, 12, 30, and 60. Granulation formation and gastric deformity were evaluated by visual analog scale (VAS) on Days 30 and 60.


RESULTS
Local TCA injection did not alter clip-to-clip distance on postoperative Day 60, and formation of flat granulation tissue over the ulcer was followed by regenerative mucosa without any gastric deformity. The sham-control group showed significant shortening of clip-to-clip distance compared with the local steroid-injected group and protruded forms of granulation tissue with mucosal convergence. Histological evaluation revealed prominent growth of neovessels, swelling, and marked increases in endothelial cells in the local steroid-injected group compared with the sham-control group.


CONCLUSIONS
Local steroid injection into the floor of a post-ESD artificial ulcer promotes the formation of granulation tissue at an early stage of the healing process leading to regeneration of gastric mucosa without mucosal convergence or gastric deformity.
Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan. hiro4884@med.kagawa-u.ac.jp
H
H
Mori
K
K
Rafiq
H
H
Kobara
S
S
Fujihara
N
N
Nishiyama
M
M
Kobayashi
T
T
Himoto
R
R
Haba
M
M
Hagiike
K
K
Izuishi
K
K
Okano
Y
Y
Suzuki
T
T
Masaki
D000230:Adenocarcinoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D061345:Early Medical Intervention; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods; D005938:Glucocorticoids / Q000008:administration & dosage; D006097:Granulation Tissue / Q000187:drug effects*; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013276:Stomach Ulcer / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014945:Wound Healing / Q000187:drug effects
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide