title: Steroid permeation into the artificial ulcer by combined steroid gel application and balloon dilatation: prevention of esophageal stricture.
abstract: OBJECTIVE
  Local steroid injection therapy is effective for preventing esophageal stricture after endoscopic submucosal dissection (ESD) but is associated with the risk of puncture-related complications, such as bleeding. We evaluated the effectiveness of the application of triamcinolone acetonide gel following permeation into a large artificial ESD ulcer by balloon dilatation compared with steroid injection.
  
  
  METHODS
  Forty-three patients who underwent ESD for early esophageal cancer approved by the institutional ethics committee and provided consent to participate in this prospective study were divided into two groups using a sealed-envelope randomization method as follows: 23 patients who were treated with local steroid injection and balloon dilatation and 20 patients were treated with steroid application and balloon dilatation. The stricture rate, the number of endoscopic balloon dilatation, and the mean procedure time on postoperative days (PODs) 5, 8, 12, 15, 20, 30, and 60 were analyzed.
  
  
  RESULTS
  No significant difference was found in the stricture rate on PODs 5, 8, 12, 15, 20, 30, and 60 between the two groups. The mean number of endoscopic balloon dilatation procedures performed for treating dysphagia that appeared on or after POD 30 was significantly different between groups (P=0.011). The mean procedure time showed no significant difference. Procedure-related bleeding during the first 30 days was observed more in the local steroid injection group than the gel application group (P=0.02).
  
  
  CONCLUSIONS
  Steroid gel application is an effective way for preventing esophageal stricture after ESD and is more effective compared with local injection in terms of prevention of stricture.
authors: Department of Gastroenterology and Neurology, Kagawa University Medical School, Kagawa, Japan. hiro4884@med.kagawa-u.ac.jp
authors: Hirohito
authors: H
authors: Mori
authors: Kazi
authors: K
authors: Rafiq
authors: Hideki
authors: H
authors: Kobara
authors: Shintaro
authors: S
authors: Fujihara
authors: Noriko
authors: N
authors: Nishiyama
authors: Makoto
authors: M
authors: Oryuu
authors: Yasuyuki
authors: Y
authors: Suzuki
authors: Tsutomu
authors: T
authors: Masaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004106:Dilatation; D004938:Esophageal Neoplasms / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology* / Q000517:prevention & control*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005782:Gels; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
chemical_list: D005782:Gels; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide