title: Prevention of esophageal strictures after endoscopic submucosal dissection with the injection of botulinum toxin type A.
abstract: OBJECTIVE
  The use of endoscopic submucosal dissection (ESD) for management of widespread superficial esophageal squamous carcinoma is closely associated with esophageal stenosis. We investigated the efficacy and feasibility of endoscopic injection of botulinum toxin type A (BTX-A) for preventing esophageal strictures after ESD for superficial esophageal squamous carcinoma.
  
  
  METHODS
  Sixty-seven patients with superficial esophageal squamous cell carcinomas with mucosal defects that exceeded one half of the circumference of the esophagus after ESD treatment were enrolled and randomly divided into 2 groups (group A, n = 33; group B, n = 34). Patients in group A (BTX-A group) were immediately injected with BTX-A after ESD, whereas patients in group B (control group) received ESD only. Endoscopy was performed when patients reported dysphagia symptoms and at 12 weeks post-ESD in patients without symptoms. Patients who experienced post-ESD esophageal strictures in both groups received bougie dilation.
  
  
  RESULTS
  The number of patients who experienced esophageal strictures in group A (per protocol analysis, 6.1%, 2/33; intention to treat analysis, 11.4%, 4/35) was significantly less than that seen in group B (per protocol analysis, 32.4%, 11/34; intention to treat analysis, 37.8%, 14/37) (P < .05). Moreover, the number of bougie dilation procedures was significantly lower in group A (mean, 1.5; range, 0-2) than in group B (mean, 2.8; range, 0-5) (P < .05).
  
  
  CONCLUSIONS
  Endoscopic injection of BTX-A was effective in preventing post-ESD esophageal strictures and decreasing the times of bougie dilation procedures. (
  
  
  BACKGROUND
  ChiCTR-TRC-12003188.).
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China; Department of Gastroenterology and Hepatology, Chinese PLA 261 Hospital, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wen
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Zhongsheng
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Enqiang
authors.initials: E
authors.lastname: Linghu
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yunsheng
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Shufang
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yan
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA 261 Hospital, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA 261 Hospital, Beijing, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Meng
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Dou
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Qingsen
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004106:Dilatation; D000069916:Endoscopic Mucosal Resection; D004938:Esophageal Neoplasms / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D004940:Esophageal Stenosis / Q000517:prevention & control* / Q000601:surgery; D004945:Esophagoscopy; D004947:Esophagus; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control* / Q000601:surgery
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A