title: Control of severe strictures after circumferential endoscopic submucosal dissection for esophageal carcinoma: oral steroid therapy with balloon dilation or balloon dilation alone.
abstract: BACKGROUND
  Recent technological advances have allowed superficially spreading intramucosal carcinomas of the esophagus to be successfully resected by circumferential endoscopic submucosal dissection (cESD). After this procedure, esophageal strictures develop in most patients and are mainly treated by endoscopic balloon dilation (EBD).
  
  
  OBJECTIVE
  To compare oral steroids plus EBD with EBD alone for the management of benign esophageal strictures after cESD.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  We studied 23 consecutive patients who underwent complete cESD for superficial esophageal carcinoma (22 squamous cell carcinomas and 1 adenocarcinoma associated with Barrett's esophagus).
  
  
  METHODS
  After cESD, patients were managed with EBD alone (EBD, n = 13) or with EBD and oral prednisolone (steroid + EBD, n = 10), 30 mg daily, started 2 days after cESD and gradually tapered and discontinued after 8 weeks.
  
  
  METHODS
  Total number of EBD sessions and total EBD period (months).
  
  
  RESULTS
  Steroid + EBD patients required fewer sessions (13.8 ± 6.9 vs 33.5 ± 22.9; P < .001) and a shorter management period (4.8 ± 2.3 vs 14.2 ± 17.5 months, P = .005) compared with the EBD group. An additional 3 patients received oral steroids a mean interval of 158 days after cESD. These patients required more EBD sessions (46.3 ± 30.0; P = .002), and the EBD period was significantly longer (17.5 ± 13.0 months; P = .005) than in the early steroid + EBD group.
  
  
  CONCLUSIONS
  Nonrandomized study; retrospective analysis.
  
  
  CONCLUSIONS
  After cESD, oral steroid therapy dramatically reduced the need for EBD. We conclude that oral steroid therapy after EBD is an effective strategy for the management of esophageal strictures after complete cESD.
authors: Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan.
authors: Hiroki
authors: H
authors: Sato
authors: Haruhiro
authors: H
authors: Inoue
authors: Yasutoshi
authors: Y
authors: Kobayashi
authors: Roberta
authors: R
authors: Maselli
authors: Esperanza Grace R
authors: EG
authors: Santi
authors: Bu'Hussain
authors: B
authors: Hayee
authors: Kenta
authors: K
authors: Igarashi
authors: Akira
authors: A
authors: Yoshida
authors: Haruo
authors: H
authors: Ikeda
authors: Manabu
authors: M
authors: Onimaru
authors: Yutaka
authors: Y
authors: Aoyagi
authors: Shin-ei
authors: SE
authors: Kudo
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000284:Administration, Oral; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004106:Dilatation / Q000379:methods*; D004210:Dissection / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy / Q000009:adverse effects; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D011239:Prednisolone / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone
keywords: EBD; ESD; cESD; circumferential endoscopic submucosal dissection; endoscopic balloon dilation; endoscopic submucosal dissection