Efficacy of viscous budesonide slurry for prevention of esophageal stricture formation after complete endoscopic mucosal resection of short-segment Barrett's neoplasia.
OBJECTIVE
Complete endoscopic resection (CER) of short-segment Barrett's esophagus with high grade dysplasia (HGD) and early esophageal adenocarcinoma (EEA) is a precise staging tool and achieves durable disease control. The major drawback is development of post-endoscopic resection esophageal stricture (PERES). No effective therapy to prevent PERES has been described. Viscous budesonide slurry (VBS) may have a role in the prevention of PERES by suppressing the post-CER inflammatory process. The study aim was to evaluate the efficacy of VBS for the prevention of PERES.


METHODS
Prospective data were collected on patients referred for CER of HGD or EEA. After January 2012, patients routinely received VBS (two 0.5-mg/2-mL budesonide respules mixed with sucralose) twice daily for 6 weeks following each stage of the CER schedule. All patients received high dose proton pump inhibitor therapy for the duration of CER and the following 3 months. Patients had no other intervention to prevent PERES. A validated dysphagia score was used (0 - 4, no dysphagia to aphagia). Endoscopic dilation was performed for dysphagia. Patients receiving VBS were compared with historical controls. The primary endpoint was the need for dilation.


RESULTS
Between January 2008 and January 2015, 104 of 116 eligible patients completed CER. The VBS group (n = 29) and non-VBS group (n = 75) had similar patient, disease, and procedural characteristics. Dilations were needed in 13.8 % vs. 37.3 % (P = 0.03), with a median of one vs. two procedures (P = 0.01), and median dysphagia score during CER of 0 vs. 1 (P = 0.02) in the VBS and non-VBS groups, respectively. No VBS-related adverse events were noted.


CONCLUSIONS
In this pilot study VBS significantly reduced PERES and shortened the dilation program after CER.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Farzan F
FF
Bahin
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Mahesh
M
Jayanna
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Stephen J
SJ
Williams
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Eric Y T
EY
Lee
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Michael J
MJ
Bourke
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D019819:Budesonide / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology / Q000517:prevention & control*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control*; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D014783:Viscosity
D000893:Anti-Inflammatory Agents; D019819:Budesonide