title: Novel method to prevent gastric antral strictures after endoscopic submucosal dissection: using triamcinolone.
abstract: Endoscopic submucosal dissection (ESD) of large gastric lesions often leads to severe gastric strictures, especially in cases of large ESD in the antrum of the stomach. It has recently been reported that balloon dilation, mucosal incision, and local steroid injections can successfully treat gastric strictures. However, there are some complications with existing methods and decreasing the quality of life. We have developed a novel method to prevent severe gastric strictures that does not involve balloon dilation, mucosal incision, or steroid injections after circumferential ESD. Our original method involves the submucosal injection of a mixed solution composed of triamcinolone acetonide and a general solution of glycerol, hyaluronic acid, and a small amount of indigo carmine and epinephrine during the ESD procedure; this mixture is called a mixed solution of triamcinolone (MST). According to standard ESD procedures, several milliliters of MST are injected into the submucosal layer for the purpose of elevating the submucosa during ESD resulting in prevention of severe strictures. Our method using MST take several advantages such as MST method suppress inflammation in ulcer from initial phase, prevention of stricture without obstructive symptoms, and does not require several ballooning. Therefore, MST method is safe and gentle, shorten the hospitalization duration. Here, we described two cases in which we prevented severe strictures of the gastric antrum after completing a circumferential ESD using MST without any complications.
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Kazi
authors.initials: K
authors.lastname: Rafiq
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Ayaki
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yachida
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Oryu
authors.affiliation: Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D003251:Constriction, Pathologic; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D005756:Gastritis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005773:Gastroscopy / Q000009:adverse effects*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011706:Pyloric Antrum / Q000187:drug effects* / Q000473:pathology / Q000601:surgery*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide
keywords: Early gastric cancer; Endoscopic submucosal dissection; Stricture of antrum; Triamcinolone