title: Novel method for the management of stenosis after gastric endoscopic submucosal dissection: mucosal incision with steroid injection contralateral to the severely contracted scar.
abstract: The aim of the present report was to investigate the efficacy of local steroid injection and oral administration contralateral to a severe contracted scar of large endoscopic submucosal dissection (ESD) for gastric cancer. Among 254 cases that underwent gastric ESD, seven patients underwent resection of more than three-quarters of the circumference of the stomach. Two patients were excluded because they did not meet curative resection criteria of Japan Gastroenterological Endoscopy Society. Therefore, in five patients, circumferentiality, symptom appearance period, and weight loss period were examined. Effect of a contralateral normal mucosa incision for releasing the stenosis followed by local injection and oral steroids were also examined. Abdominal bloating, vomiting, and loss of appetite appeared 42 days on average after gastric ESD, whereas weight loss >5 kg was observed an average of 52.6 days after gastric ESD. Average contralateral mucosal incision length was 51 mm, whereas the average mucosal incision width was 31 mm. All patients underwent a mucosal incision and were given a local injection of 100 mg triamcinolone acetonide. Two patients received an additional 20 mg oral steroid. In cases combined with oral steroid, there was no re-stenosis after the mucosal incision, but two to three balloon dilatations were necessary in three cases in which oral steroids were not given. This method is considered useful for stenosis after large ESD for gastric cancer.
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.affiliation: Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Kazi
authors.initials: K
authors.lastname: Rafiq
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Ayaki
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yachida
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002921:Cicatrix / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004210:Dissection / Q000009:adverse effects*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D017219:Gastric Outlet Obstruction / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000601:surgery*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide
keywords: contralateral mucosal incision; large antral resection; local steroid injection; stenosis; steroid