title: Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study.
abstract: OBJECTIVE
  The frequency of stricture after endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma with a mucosal defect involving more than three-quarters of the circumference is 70% - 90%. Stricture decreases quality of life and requires multiple endoscopic balloon dilation (EBD) sessions. We investigated the efficacy and safety of a single session of intralesional steroid injections to prevent post-ESD stricture.
  
  
  METHODS
  We conducted a prospective study on 30 patients with esophageal squamous cell carcinoma treated by ESD, who had a more than three-quarter but less than whole circumferential defect. A single session of intralesional steroid injections was undertaken immediately after ESD. Esophagogastroduodenoscopy was performed whenever patients reported dysphagia and 2 months after ESD in patients without dysphagia. Results were compared with a historical control group of 29 patients who underwent ESD without intralesional steroid injection. The primary endpoint was the post-ESD stricture rate. Secondary endpoints were the number of EBD sessions and the complication rate.
  
  
  RESULTS
  Compared with the historical control group, the study group had a significantly lower stricture rate (10%, 3/30 patients vs. 66%, 19/29 patients; P < 0.0001) and a lower number of EBD sessions (median 0, range 0 - 2 vs. median 2, range 0 - 15; P < 0.0001). The study group had a complication rate of 7 % (2 /30 patients), comprising a submucosal tear in one patient and bleeding in another, which were not a direct result of EBD.
  
  
  CONCLUSIONS
  A single session of intralesional steroid injections showed promising results for the prevention of stricture after ESD for esophageal cancer.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. hanaoka-no@mc.pref.osaka.jp
authors.forename: N
authors.initials: N
authors.lastname: Hanaoka
authors.forename: R
authors.initials: R
authors.lastname: Ishihara
authors.forename: Y
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: N
authors.initials: N
authors.lastname: Uedo
authors.forename: K
authors.initials: K
authors.lastname: Higashino
authors.forename: T
authors.initials: T
authors.lastname: Ohta
authors.forename: H
authors.initials: H
authors.lastname: Kanzaki
authors.forename: M
authors.initials: M
authors.lastname: Hanafusa
authors.forename: K
authors.initials: K
authors.lastname: Nagai
authors.forename: F
authors.initials: F
authors.lastname: Matsui
authors.forename: H
authors.initials: H
authors.lastname: Iishi
authors.forename: M
authors.initials: M
authors.lastname: Tatsuta
authors.forename: Y
authors.initials: Y
authors.lastname: Ito
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D016145:Endoscopy, Digestive System; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
chemical_list: D014222:Triamcinolone Acetonide