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Yang D, Hasan MK, Xiao Y, Gabr M, Jawaid S, Khalaf MA, Sharma NS, Rojas De Leon MJ, Othman MO, Draganov PV. The use of a self-assembling peptide gel for stricture prevention in the esophagus after endoscopic submucosal dissection: a U.S. multicenter prospective study (with video). Gastrointest Endosc 2024; 100:213-220. [PMID: 38467200 DOI: 10.1016/j.gie.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND AND AIMS Postoperative stricture is a serious common adverse event after extensive endoscopic submucosal dissection (ESD) in the esophagus. Self-assembling peptide (SAP) gel has been shown to promote tissue healing and re-epithelialization. The aim of this study was to evaluate the effect of the SAP gel for esophageal stricture prevention after ESD. METHODS This was a multicenter prospective study of patients who underwent esophageal ESD followed by SAP gel application between March 2022 and December 2023. Patients were included if the ESD mucosal defect involved ≥50% of the circumference of the esophagus. High-risk cases were defined as mucosal defects ≥75% of the circumference. Stricture was defined as the inability to pass an endoscope ≥8.9 mm in diameter or a narrow-caliber lumen in a patient with symptoms. RESULTS A total of 43 patients (median age, 71 years; 81.4% male) underwent ESD (median resected specimen size, 50 mm) during the study period. SAP gel (median, 3 mL) was successfully applied in all cases (median time, 4 minutes). In aggregate, stricture occurred in 20.9% (9 of 43) of the cases. Stricture developed in 30.8% of the high-risk cases: 80% (4 of 5) after circumferential ESD and 19% (4 of 21) in those with defects ≥75% but <100% of the circumference. All cases of stricture resolved with endoscopic treatment. Three cases (6.9%) of postoperative bleeding occurred and were adequately managed endoscopically. CONCLUSIONS We show that SAP gel application was easy, quick, and associated with a relatively low stricture rate comparable to other prophylactic methods. Additional comparative studies are needed to corroborate these preliminary findings.
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Affiliation(s)
- Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
| | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Yasi Xiao
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Moamen Gabr
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Salmaan Jawaid
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Mai A Khalaf
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Neil S Sharma
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | | | - Mohamed O Othman
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
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Tasaki Y, Yamazaki T, Miyazaki S, Takeda T, Nakatake M, Nakamura D, Takahira A, Honda K, Egawa A, Yamaguchi N, Nakao K, Toya R. Additional chemoradiotherapy for superficial esophageal squamous cell carcinoma after near-circumferential or full-circumferential noncurative endoscopic submucosal dissection: a retrospective study. BMC Gastroenterol 2024; 24:232. [PMID: 39044174 PMCID: PMC11267816 DOI: 10.1186/s12876-024-03328-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/16/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a potentially efficient therapeutic intervention for superficial esophageal cancer. Additional treatment such as chemoradiotherapy (CRT) or esophagectomy is recommended in cases of muscularis mucosa invasion with positive resection margins or lymphovascular invasion or submucosal layer invasion, which are considered noncurative ESD, due to an increased risk of lymph node metastasis. However, the adequacy of additional CRT after near-circumferential or full-circumferential noncurative ESD has not been fully discussed. In this study, we retrospectively evaluated the efficacy and toxicity of additional CRT for superficial esophageal squamous cell carcinoma (SCC) after near-circumferential or full-circumferential noncurative ESD, which was defined as a mucosal defect measuring ≥ 3/4 of the esophageal circumference. METHODS We retrospectively evaluated 24 patients who received additional CRT for superficial esophageal SCC after near-circumferential or full-circumferential noncurative ESD between 2012 and 2018. Elective nodal irradiation (ENI) was performed in all patients and boost irradiation (BI) was performed after ENI in 4 patients with positive resection margins. The prescription doses of ENI and BI were 41.4 Gy in 23 fractions and 9 Gy in 5 fractions, respectively. Concurrent chemotherapy (a combination of cisplatin or nedaplatin and 5-fluorouracil) was administered to all patients. RESULTS The 3-year and 5-year overall survival rates were 92% and 78%, respectively, while the 3-year and 5-year progression-free survival rates were 83% and 70%, respectively. Grade 2 esophageal stenosis occurred in 8 (33%) patients. There was no case of Grade 3 or worse esophageal stenosis. Among them, 4 (17%) patients developed stenosis before additional CRT, which persisted after the completion of additional CRT. The remaining 4 (17%) patients developed de novo stenosis within 5 months following the completion of additional CRT. One patient (4%) still requires regular bougie dilation. Grade 3 and Grade 4 acute toxicity, including anemia, neutropenia, thrombocytopenia, and esophagitis occurred in 1 (4%) and 0 (0%), 6 (25%) and 1 (4%), 1 (4%) and 0 (0%), and 1 (4%) and 0 (0%) patients, respectively. One (4%) patient who underwent salvage CRT for the out-of-field lymph node recurrence died with acute myeloid leukemia. CONCLUSIONS Additional CRT is a viable treatment option even in patients who have undergone near-circumferential or full-circumferential noncurative ESD. Esophageal stenosis after additional CRT following near-circumferential or full-circumferential noncurative ESD is manageable and acceptable.
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Affiliation(s)
- Yutaro Tasaki
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takuya Yamazaki
- Department of Radiology, Sasebo Central Hospital, 15 Daiwa, Sasebo, 857-1195, Japan
| | - Shuhei Miyazaki
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tatsuya Takeda
- Department of Radiology, National Hospital Organization Nagasaki Medical Center, 1000-1 Kubara, Omura, 856- 8562, Japan
| | - Mika Nakatake
- Department of Radiology, Japanese Red Cross Nagasaki Genbaku Hospital, 3-15 Mori, Nagasaki, 852-8511, Japan
| | - Daisuke Nakamura
- Department of Radiology, National Hospital Organization Nagasaki Medical Center, 1000-1 Kubara, Omura, 856- 8562, Japan
| | - Asuka Takahira
- Department of Radiology, Japanese Red Cross Nagasaki Genbaku Hospital, 3-15 Mori, Nagasaki, 852-8511, Japan
| | - Koichi Honda
- Department of Clinical Oncology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Akiko Egawa
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Naoyuki Yamaguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852- 8501, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852- 8501, Japan
| | - Ryo Toya
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Duan Y, Jia W, Liang Y, Zhang X, Yang Z, Yang Q. Progress in the treatment and prevention of esophageal stenosis after endoscopic submucosal dissection. Clin Res Hepatol Gastroenterol 2024; 48:102290. [PMID: 38311060 DOI: 10.1016/j.clinre.2024.102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
The primary treatment for early esophageal cancer and precancerous lesions is endoscopic submucosal dissection (ESD). However, this approach leads to a high incidence of postoperative esophageal stenosis, which can significantly impact a patient's quality of life. While various methods are available to prevent post-ESD esophageal stenosis, their effectiveness varies. Therefore, this study aims to provide an overview of the currently employed methods for preventing post-ESD esophageal stenosis in clinical practice in view of assisting clinical practitioners.
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Affiliation(s)
- Yangyang Duan
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Wenxiu Jia
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Ying Liang
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Xiuning Zhang
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Zhufeng Yang
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China.
| | - Qian Yang
- Department of Spleen and Stomach Diseases, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China; Hebei Key Laboratory of Turbidity Toxin Syndrome, Hebei, China; Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China.
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Rodríguez de Santiago E, Herreros-de-Tejada A, Albéniz E, Ramos Zabala F, Fernández-Esparrach G, Nogales O, Rosón P, Peñas García B, Uchima H, Terán Á, Rodríguez Sánchez J, de Frutos D, Parejo Carbonell S, Santiago J, Díaz Tasende J, Guarner Argente C, de María Pallarés P, Amorós A, Barranco D, Álvarez de Castro D, Muñoz González R, Marín-Gabriel JC. Implementation of esophageal endoscopic submucosal dissection in Spain: Results from the nationwide registry. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:119-129. [PMID: 36870477 DOI: 10.1016/j.gastrohep.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/24/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION AND AIMS The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique. MATERIAL AND METHODS Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection. RESULTS A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (n=79; 95%CI: 68%-84%) and 63.7% (n=65; 95%CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (n=55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (n=25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14months, 20patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%). CONCLUSIONS In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España.
| | - Alberto Herreros-de-Tejada
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España; Hospital La Luz, QuirónSalud, Madrid, España
| | - Eduardo Albéniz
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Universitario de Navarra NavarraBiomed, Universidad Pública de Navarra (UPNA), IdisNA, Pamplona, España
| | - Felipe Ramos Zabala
- Servicio de Gastroenterología, Hospital Universitario HM Montepríncipe, Grupo HM hospitales, Boadilla del Monte, Madrid, España
| | - Gloria Fernández-Esparrach
- Sección de Endoscopia, Servicio de Gastroenterología, ICMDM, Hospital Clínic de Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer. CIBEREHD. Universidad de Barcelona, Barcelona, España
| | - Oscar Nogales
- Servicio de Gastroenterología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Pedro Rosón
- Servicio de Aparato Digestivo, Hospital Vithas Xanit internacional Málaga, Málaga, España
| | - Beatriz Peñas García
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Hugo Uchima
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro Médico Teknon, Barcelona, España
| | - Álvaro Terán
- Servicio de Gastroenterología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, España
| | - Joaquín Rodríguez Sánchez
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España; Servicio de Gastroenterología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Diego de Frutos
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
| | - Sofía Parejo Carbonell
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - José Santiago
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
| | - José Díaz Tasende
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España
| | - Charly Guarner Argente
- Servicio de Gastroenterología, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, España
| | | | - Ana Amorós
- Servicio de Gastroenterología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Daniel Barranco
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Universitario de Navarra NavarraBiomed, Universidad Pública de Navarra (UPNA), IdisNA, Pamplona, España
| | - Daniel Álvarez de Castro
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Raquel Muñoz González
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro Médico Teknon, Barcelona, España
| | - José Carlos Marín-Gabriel
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España
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Ren K, Wang J, Li Y, Li Z, Zhou Z, Wu K, Li Y, Ge X, Ren J, Han X. Paclitaxel-coated balloon catheter for benign esophageal stenosis in a rabbit model. Sci Rep 2024; 14:2551. [PMID: 38291135 PMCID: PMC10827726 DOI: 10.1038/s41598-024-53078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/27/2024] [Indexed: 02/01/2024] Open
Abstract
Most patients with benign esophageal stenosis require multiple or even continuous balloon dilation treatments to achieve symptom relief. In this study, eighteen rabbits were used to establish an esophageal benign stenosis model and were divided into a control group (n = 6), a balloon group (n = 6) and a PTX-coated balloon group (n = 6) to evaluate the feasibility and effectiveness of paclitaxel (PTX)-coated balloons for the rabbit esophageal benign stenosis model. The weight and esophageal diameter were recorded every 2 weeks until 8 weeks post-surgery. Hematoxylin-eosin staining, Masson's trichrome staining and immunohistochemical staining were performed for pathological analysis. Four weeks post-operation, there was a significant difference in weight between the control group and the balloon group (p = 0.01) and between the control group and the PTX balloon group (p = 0.01). There was a significant difference in the esophageal diameter between the balloon group and the PTX balloon group at 8 weeks post-operation (p = 0.02). Four weeks post-operation, the degree of inflammatory cell infiltration in the PTX balloon group was significantly lower than that in the control group (p = 0.002) and balloon group (p = 0.001). The degree of collagen deposition in the PTX balloon group was significantly lower than that in the control group (p = 0.002) and balloon group (p = 0.03). Eight weeks post-operation, the percentage of cells positive for TGF-β (p < 0.001), the degree of inflammatory cell infiltration (p = 0.02) and the degree of collagen deposition (p = 0.02) in the PTX balloon group were significantly lower than those in the balloon group. Therefore, PTX-coated balloons may alleviate the local inflammatory response and collagen deposition when used during dilation treatment of benign esophageal stenosis.
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Affiliation(s)
- Kewei Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
- Engineering Technology Research Center for Minimally Invasive, Interventional Tumors of Henan Province, Zhengzhou, Henan, 450052, People's Republic of China.
| | - Jianan Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Department of Interventional Radiotherapy, Zhoukou Center Hospital, Zhoukou, 46000, People's Republic of China
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zongming Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zihe Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Kunpeng Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yifan Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xiaoyong Ge
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
- Interventional Treatment and Clinical Research Center of Henan Province, Zhengzhou, 450052, People's Republic of China.
- Interventional Institute of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
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Kim MJ, Ryu DG, Park SB, Choi CW, Kim HW, Kim SJ. Esophageal Stricture after Endoscopic Drainage of Esophageal Abscess as a Complication of Acute Phlegmonous Esophagitis: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:262-266. [PMID: 36567439 DOI: 10.4166/kjg.2022.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 12/27/2022]
Abstract
Esophageal abscess caused by acute phlegmonous esophagitis is rare but life-threatening. Rapid abscess drainage is an important part of the treatment, and endoscope-assisted intra-luminal abscess drainage is frequently performed. Although endoscopic drainage is less invasive than surgery, it has the potential to cause esophageal stricture as a complication. We present a rare case of esophageal stricture as a complication of intra-luminal drainage and evaluate a method to minimize the incidence of esophageal stricture complications.
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Affiliation(s)
- Min Ji Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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Han Z, Pan L, Lu B, Zhu H. MicroRNA-21 as a potential biomarker for detecting esophageal carcinoma in Asian populations: a meta-analysis. PeerJ 2022; 10:e14048. [PMID: 36199284 PMCID: PMC9528905 DOI: 10.7717/peerj.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/22/2022] [Indexed: 01/19/2023] Open
Abstract
Background MicroRNA-21 (miR-21) is significantly expressed in a variety of cancers and could be used as a tumor biomarker. However, the results are varied, and no studies on the diagnostic usefulness of miR-21 in Asian esophageal cancer (EC) patients have been published. This meta-analysis was aimed at exploring whether miR-21 can be used as a diagnostic marker and assessing its effectiveness. Methods The relevant literature was identified in six main databases: Ovid MEDLINE, PsycINFO, PubMed MEDLINE, Embase, Web of Science, and the Cochrane Library. Two researchers independently selected the literature based on the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias. The meta-analysis was carried out using Review Manager 5.4, Meta-Disc 1.4 and STATA 15.1 software. In the end, 987 patients from 12 different studies were included. Quality evaluation of diagnostic accuracy studies 2 (QUADAS-2) was used to examine the risk of bias. Results The pooled sensitivity (SEN) was 0.72 (95% CI [0.69-0.75]), the pooled specificity (SPE) was 0.78 (95% CI [0.75-0.81]), the pooled positive likelihood ratio (PLR) was 2.87 (95% CI [2.28-3.59]), the pooled negative likelihood ratio (NLR) was 0.36 (95% CI [0.31-0.43]), the pooled diagnostic odds ratio (DOR) was 10.00 (95% CI [7.73-12.95]), and the area under the curve 0.82 (95% CI [0.79-0.85]). A Deeks' funnel plot shows that there was no publication bias (P = 0.99). Conclusion Our findings suggest miR-21 might be the potential biomarker for detecting EC in Asian populations, with a good diagnostic value.
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Jia Y, Guo B, Zhang W, Li E, Zhang Q. Efficacy and safety of triamcinolone acetonide in the prevention of esophageal stricture after endoscopic submucosal dissection: a meta-analysis. Dis Esophagus 2022; 35:6640325. [PMID: 35829658 DOI: 10.1093/dote/doac039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/27/2022] [Indexed: 12/11/2022]
Abstract
AIM The role of triamcinolone acetonide (TA) in the prevention of esophageal stricture is not well established. This meta-analysis aimed to evaluate its safety and efficacy for the prevention of esophageal stricture after endoscopic submucosal dissection (ESD). METHODS A comprehensive search was performed in electronic databases including PubMed, the Cochrane Library, Embase for possible controlled studies. The primary outcomes were stenosis rate and endoscopic balloon dilatation (EBD) sessions required, and secondary outcome included complications. Random effects were used to calculate the pooled outcome. Sensitivity analysis and publication bias were conducted to verify the robustness and reliability of the results. Results: Ten studies containing 499 patients were obtained. In the pooled analysis, statistical significance was found in triamcinolone acetonide injection reduced the incidence of stenosis (OR = 0.29, 95% CI [0.11, 0.80], P < 0.05) and the number of endoscopic balloon dilation (MD = -3.33, 95% CI [-4.15, -2.50], P < 0.0001) compared with control. Triamcinolone acetonide injection therapy did not increase the risk of complications (OR = -0.77%, CI [-1.62, 0.09], P = 0.08). Subgroup analysis indicated that the single injection of triamcinolone acetonide after endoscopic submucosal dissection significantly reduced the incidence of stenosis compared with without any prophylaxis. Different concentrations and single session volume of triamcinolone acetonide reduced the incidence of stenosis. It also showed that the dose according to the size of the lesion was more effective than the fixed dose in preventing esophageal stricture. Conclusion: Triamcinolone acetonide injection can reduce the incidence of stricture formation as well as the need for EBD sessions without increasing complications.
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Affiliation(s)
- Yuting Jia
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
| | - Bin Guo
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
| | - Wenbin Zhang
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
| | - Erfeng Li
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
| | - Quanmao Zhang
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
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Zhang B, Zhang Y, Wang Y, Yang F, Sheng S, Wang Z, Chang X, Wei J, Guo J, Sun S. Acellular Dermal Matrix Prevents Esophageal Stricture After Full Circumferential Endoscopic Submucosal Dissection in a Porcine Model. Front Bioeng Biotechnol 2022; 10:884502. [PMID: 35586551 PMCID: PMC9108161 DOI: 10.3389/fbioe.2022.884502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
Esophageal stricture is a common complication after endoscopic submucosal dissection (ESD), especially in full circumferential ESD. This study investigated fully covered self-expanding metal stent (FCSEMS) placement with an acellular dermal matrix (ADM) for preventing post-ESD esophageal stricture. Twelve Bama minipigs were randomly divided into two groups, which underwent full circumferential ESD in the distal esophagus. In group A, an FCSEMS with ADM was placed at the mucosal defect, whereas group B underwent standard FCSEMS placement. The stent was removed during gastroscopy 2 weeks after the ESD procedure. At the fourth week, gastroscopy was repeated to evaluate local healing and stenosis. The animals were sacrificed, esophageal specimens were obtained for macroscopic and histological evaluation, and serum C-reactive protein (CRP) levels were quantified. Four weeks post ESD, dysphagia occurrence was lesser in group A than in group B. Group A demonstrated lesser esophageal stricture on macroscopic evaluation (21.02 ± 16.65% vs. 57.41 ± 8.48%, p = 0.001) in the form of enhanced re-epithelization (99.13 ± 0.98% vs. 96.63 ± 1.64%, p = 0.009), diminished submucosal fibrosis (1117.53 ± 188.83 um vs. 1834.69 ± 421.99 um, p = 0.003), and attenuated inflammatory infiltration (121.00 ± 30.66 vs. 188.17 ± 64.92, p = 0.045). The increase in the serum CRP level was lower in group A than in group B at 4 weeks post-ESD. FCSEMS combined with ADM can enhance re-epithelization in the process of wound healing and significantly reduce the degree of esophageal stenosis after circumferential ESD. This study provided important preclinical findings for subsequent clinical trials.
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Affiliation(s)
- Baozhen Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yidan Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shiyun Sheng
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhe Wang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoying Chang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianyu Wei
- Medical Transformation Department, Micro-Tech (Nanjing) Co. Ltd., Nanjing, China
| | - Jintao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Jintao Guo, ; Siyu Sun,
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Jintao Guo, ; Siyu Sun,
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10
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Lin N, Lin J, Gong J. Risk factors of postoperative stricture after endoscopic submucosal dissection for superficial esophageal neoplasms: A meta-analysis. Medicine (Baltimore) 2021; 100:e28396. [PMID: 34941174 PMCID: PMC8701733 DOI: 10.1097/md.0000000000028396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/21/2021] [Accepted: 11/27/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND As larger-sized superficial esophageal neoplasms became candidates for endoscopic submucosal dissection (ESD), post-ESD esophageal stricture has inevitably developed into a significant complication during long-term follow-up. METHOD The PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, as well as China National Knowledge Infrastructure, the Wanfang Database, and the Chinese Biomedical Literature Database, were searched to identify all the appropriate studies published from January 2000 through October 2019. For risk factor assessment between postoperative stricture and control groups, pooled odds ratios (OR) and weighted mean differences (WMD) estimation was done. All meta-analytical procedures were conducted by using Stata version 15.1 software. RESULTS The results showed that 11 studies with 2248 patients (284 structure cases and 1964 controls) were eligible for this meta-analysis. Statistical results indicated 6 substantial risk factors: lesion characteristics involving the upper third of the esophagus (OR 1.51, [1.02-2.25]), macroscopic type of IIa/IIc (OR 2.76, [1.55-4.92]), tumor depth of invasion above m1 (OR 7.47, [3.31-16.86]), and m2 (OR 12.67, [4.00-40.10]), longitudinal length (WMD 13.75 mm, [7.76-19.74]), circumferential diameter (WMD 10.87 mm, [8.13-13.60]), and circumferential range >3/4 (OR 38.17, [9.94-146.52]). Each additional 10% of the circumferential range increased the risk of stricture by 149% (OR 9282.46, [978.14-88089.35]). CONCLUSIONS Six risk factors were assessed to have a key role in the elevated risk levels of post-ESD esophageal stricture. The results can help doctors identify patients with increased risk and thus can guide management of the adequate period of surveillance after ESD and take available approaches of stricture prevention.
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11
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Othman MO, Bahdi F, Ahmed Y, Gagneja H, Andrawes S, Groth S, Dhingra S. Short-term clinical outcomes of non-curative endoscopic submucosal dissection for early esophageal adenocarcinoma. Eur J Gastroenterol Hepatol 2021; 33:e700-e708. [PMID: 34091478 DOI: 10.1097/meg.0000000000002223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Few Western studies highlighted the outcomes of endoscopic submucosal dissection (ESD) for early esophageal adenocarcinoma (EAC). Data regarding the outcomes of noncurative ESDs remains scarce. In this study, we share our experience with ESD for early EAC with a focus on noncurative ESDs. METHODS A retrospective single-center analysis of consecutive patients who underwent ESD for early EAC from August 2015 through February 2020. Primary outcomes included the clinical outcomes of noncurative ESDs along with overall en bloc, R0 and curative resection rates. Secondary outcomes included comparing results between T1a and T1b tumors. RESULTS Final group included 23 T1a and 17 T1b EAC patients. Patients' median Charlson comorbidity index was five. En bloc resection rate was (97.5%). Compared to the T1b group, the T1a group had a statistically significantly higher R0 (78.3 vs. 41.2%; P = 0.0235), curative (73.9 vs. 11.8%; P = 0.0001) and accumulative endoscopic curative resection rates (82.6 vs. 23.5%; P = 0.0003). A study flowchart is presented in (Fig. 1). Out of the 21 noncurative ESDs, 10 patients (47.6%) underwent R0 esophagectomy, 6 patients (28.6%) are undergoing surveillance endoscopies without additional therapy, 3 patients (14.3%) underwent repeat curative ESD and 1 patient (4.76%) is receiving chemotherapy with surveillance endoscopy. Over median endoscopic follow-up of 22.5 months (IQR, 14.25-30.75), 2 out of 10 patients with noncurative ESDs had recurrent disease. CONCLUSIONS ESD achieved a higher curative resection rate in T1a EAC when compared to T1b. Despite a lower curative resection rate in T1b EAC, certain patients might benefit from a conservative multimodal therapy.
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Affiliation(s)
- Mohamed O Othman
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine.,Baylor St Luke's Medical Center
| | - Firas Bahdi
- Baylor St Luke's Medical Center.,Department of Medicine, Baylor College of Medicine, Houston
| | | | | | - Sherif Andrawes
- Division of Gastroenterology, Staten Island University Hospital, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Staten Island University Hospital, Staten Island, New York
| | - Shawn Groth
- Baylor St Luke's Medical Center.,Division of General Thoracic Surgery, Baylor College of Medicine
| | - Sadhna Dhingra
- Baylor St Luke's Medical Center.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
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12
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Zhang BZ, Zhang Y, Wang YD, Liao Y, Zhang JJ, Wu YF, Xiao TY, Sun SY, Guo JT. Stent placement to prevent strictures after esophageal endoscopic submucosal dissection: a systematic review and meta-analysis. Dis Esophagus 2021; 34:6201941. [PMID: 33786604 DOI: 10.1093/dote/doab015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/11/2021] [Accepted: 03/06/2021] [Indexed: 12/11/2022]
Abstract
Endoscopic submucosal dissection (ESD) is an important method for the treatment of early esophageal cancer. However, post-procedure stenosis is one of the most common long-term complications. This meta-analysis aimed to investigate whether stent placement is effective in the stenosis prevention, and which type of stent would be more effective. A systematic and electronic search of clinical trials and observational studies conducted before March 2020 on the efficacy of stent placement in preventing esophageal stricture after ESD was performed. Search terms included "ESD," "esophageal stenosis," "esophageal stricture," and "stents." We conducted a bias risk assessment of the eligible reports and a meta-analysis of the data using Revman 5.3 software. We included two randomized controlled trials (RCTs) and a prospective cohort study involving 163 patients with esophageal mucosal defects encompassing at least three-quarters of the esophagus circumference after ESD. The meta-analysis results showed that post-ESD stenosis rates (RR, 0.37; 95% CI, 0.22-0.64; P = 0.0003) and the number of endoscopic balloon dilations (EBDs) (MD, -1.74; 95% CI, -2.46 to -1.01; P < 0.00001) were reduced in the pooled analysis of three studies, indicating that stent placement was effective for stenosis prevention, especially a polyglycolic acid (PGA) sheet combined with stent placement can prevent stenosis (RR, 0.41; 95% CI, 0.23-0.74; P = 0.003) and reduce the number of EBDs (MD, -1.65; 95% CI, -2.40 to -0.90; P < 0.0001) significantly. Stent placement can reduce the rate of esophageal stenosis after ESD, especially when stents are covered with PGA sheets. However, more high-quality, low-bias RCTs with a sufficient sample size are needed to demonstrate its effectiveness.
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Affiliation(s)
- Bao-Zhen Zhang
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Yue Zhang
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Yi-Dan Wang
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Ye Liao
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Jing-Jing Zhang
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Yu-Fan Wu
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Ting-Yue Xiao
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Si-Yu Sun
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Jin-Tao Guo
- Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China
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13
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Hsu MH, Wang WL, Chen TH, Tai CM, Wang HP, Lee CT. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan. BMC Gastroenterol 2021; 21:308. [PMID: 34344303 PMCID: PMC8330105 DOI: 10.1186/s12876-021-01888-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Background Endoscopic submucosal dissection (ESD) is gradually turning into the standard treatment for superficial esophageal squamous cell carcinoma (SESCC), however, the long-term outcomes have hardly ever been reported outside Japan. Method We consecutively recruited patients with SESCC who had received ESD treatment at E-Da Hospital. The demographics, pathological characteristics, and Lugol staining background pattern (type A or B: none or < 10 small Lugol-voiding lesions [LVLs]; type C or D: > 10 small or multiform LVLs) were collected, and then correlated to outcomes and survival. Results Total of 229 lesions were enrolled and the mean lesion size was 3.28 ± 1.69 (range 1–10) cm. 72% of the lesions had a type C-D Lugol staining background pattern. After ESD, the en bloc and R0 resection rates were 93.9% and 83.5%, respectively. Forty-nine subjects developed complications, including six (2.6%) with major bleeding, two (0.9%) with perforation, and 41 (17.9%) with strictures. Pathological staging showed that 19 cases had deep submucosal cancer invasion and subsequently received adjuvant therapies. During a mean follow-up period of 52.6 (range 3–146) months, 41 patients developed metachronous recurrence. The patients with a type C-D Lugol staining background pattern were associated with a higher risk of recurrence than those with few LVLs (log-rank P = 0.019). The 10-year survival rate was more than 90%, and only eight patients died of ESCC. Conclusion ESD has excellent long-term outcomes but a high risk of metachronous recurrence. The Lugol staining pattern over the background mucosa could offer the risk stratification of metachronous recurrence.
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Affiliation(s)
- Ming-Hung Hsu
- Department of Internal Medicine, E-Da Hospital/I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan
| | - Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan. .,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
| | - Tzu-Haw Chen
- Department of Internal Medicine, E-Da Hospital/I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan
| | - Chi-Ming Tai
- Department of Internal Medicine, E-Da Hospital/I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Tai Lee
- Department of Internal Medicine, E-Da Hospital/I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan.
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14
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Mathies D, Oyama T, Steinbrück I, Dumoulin FL. Topical oro-dispersible budesonide tablets for stricture prevention after near circumferential ESD for esophageal squamous cell cancer - a case report. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:454-456. [PMID: 33735916 DOI: 10.1055/a-1409-1076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic resection is the treatment of choice for early esophageal cancers. However, resections comprising more than 70-80 % of the circumference are associated with a high risk of stricture formation. Currently, repetitive local injections and/or systemic steroids are given for prevention. CASE REPORT We present here the case of a 78-year-old male patient who had a near circumferential endoscopic submucosal dissection for a pT1a mm, L0, V0, R0, G2 esophageal squamous cell cancer. At the end of endoscopic resection, 80 mg of triamcinolone was injected locally. The patient was then treated with oro-dispersible budesonide tablets (2 × 1 mg/day) and nystatin (4 × 100 000 I.E.) for 8 weeks. This treatment resulted in complete healing without any stricture formation and did not result in any complications. DISCUSSION Treatment with orodispersible budesonide tablets could help prevent strictures after large endoscopic resections in the esophagus.
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Affiliation(s)
- Daniel Mathies
- Department of Medicine and Gastroenterology, Academic Teaching Hospital, University of Bonn, Bonn, Germany
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Nagano, Japan
| | - Ingo Steinbrück
- Department of Medicine, Academic Teaching Hospital, University of Freiburg, Freiburg, Germany
| | - Franz Ludwig Dumoulin
- Department of Medicine and Gastroenterology, Academic Teaching Hospital, University of Bonn, Bonn, Germany
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15
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Histological changes in the human esophagus following triamcinolone injection to prevent esophageal stricture after endoscopic submucosal dissection. Esophagus 2021; 18:594-603. [PMID: 33651217 PMCID: PMC8172396 DOI: 10.1007/s10388-021-00818-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Locoregional steroid injection prevents post-endoscopic submucosal dissection (ESD) esophageal stricture, but histological changes that occur following steroid injection in the human esophagus are unclear. This study investigated the histopathological characteristics caused by locoregional triamcinolone acetonide (TA) injection using human esophagectomy specimens. METHODS From January 2014 to December 2019, among 297 patients (373 lesions) who underwent esophageal ESD, 13 patients who underwent additional esophagectomy after ESD were examined. Seven patients (TA group) with wide excisions were injected with TA after ESD and another six patients (Non-TA group) with smaller tumors were not injected with TA. The clinical background of these patients and histopathological features of ESD ulcer scar obtained from esophagectomy specimens were retrospectively investigated. RESULTS The circumferential rate of ESD excision was more than three-quarters in all cases in the TA group, whereas it was less than three-quarters in the Non-TA group. No other statistical difference in the clinical background was found between the two groups. The subepithelial fibrous tissue of the ESD ulcer scar in the TA group was significantly thinner than that in the Non-TA group (P < 0.05). There was no significant difference in the thickness of the regenerated epithelium and muscularis propria layer of the ESD ulcer scar. CONCLUSIONS Histological finding of thinning of the subepithelial fibrous tissue of ESD ulcer scar in the human esophagus after TA injection was obtained. This suggests that TA suppresses the proliferation of the fibrous tissue of the subepithelial layer to help prevent esophageal stricture after widespread ESD in the human esophagus.
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16
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Flexible endoscopic strategies for the difficult esophageal stricture. Curr Opin Gastroenterol 2020; 36:379-384. [PMID: 32618615 DOI: 10.1097/mog.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Benign strictures of the esophagus, caused by various causes, are frequently encountered in clinical practice. Although endoscopic dilation is still the standard and first-line therapy, complex and difficult esophageal strictures are still encountered and remain a challenge to endoscopists. The main scope of this review article is to offer a closer look at the different endoscopic modalities and approaches to complex and difficult esophageal strictures. RECENT FINDINGS In the past few years, endoscopic dilatation, stents including self-expandable and biodegradable types, incisional therapy, and pharmacological treatments have been utilized in the prevention and management of refractory and recurrent esophageal strictures. Meanwhile, more recent techniques such as the BougieCap, percutaneous transgastric endoscopic myotomy, through-the-scope stents, radial incision and cutting, etc. have been developed as alternative methods. A number of studies utilizing these newer methods have shown promising results in the treatment of complex and difficult esophageal strictures. SUMMARY Endoscopic treatment of refractory, complex and difficult esophageal strictures still remains to be a challenge for many endoscopists. While balloon or bougie dilatation still remains to be the first-line approach, other techniques have emerged as treatment alternatives and may become adjunct therapy to endoscopic dilatation.
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17
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Tang J, Kong F, Li J, Liu F, Kong X, Li Z. Independent risk factors for esophageal refractory stricture after extensive endoscopic submucosal dissection. Surg Endosc 2020; 35:3618-3627. [DOI: 10.1007/s00464-020-07840-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022]
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18
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Liang C, Tan Y, Lu J, Le M, Liu D. Endoscopic incision for treatment of benign gastrointestinal strictures. Expert Rev Gastroenterol Hepatol 2020; 14:445-452. [PMID: 32380885 DOI: 10.1080/17474124.2020.1766966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Benign gastrointestinal strictures are common, and can be congenital or acquired (anastomotic, corrosive, induced by Crohn's disease or endoscopic treatments, etc.). Patients usually present with stricture-related symptoms such as vomiting, dysphagia, dyschezia, abdominal pain, which impair their quality of life. Endoscopic balloon dilation (EBD) is the first-line treatment for most of the benign strictures; however, long-term efficacy is suboptimal, and the recurrence rate can be up to 38%. Endoscopic incision (EI) was firstly reported for treatment of congenital membranous stricture, and then applied to other benign gastrointestinal strictures. AREA COVERED In the present review, we provided a comprehensive review of EI for the treatment of benign gastrointestinal strictures, mainly focus on the technical details, indication, safety, and efficacy of EI. The present review is expected to provide tips for operators who are going to perform EI. EXPERT OPINION EI can serve as an alternative method for treatment of gastrointestinal strictures, the best indications are congenital membranous stricture and short-segmental (<1 cm) anastomotic strictures refractory to EBD. EI may also be attempted for strictures induced by other reasons. Combination with other endoscopic methods such as EBD, local steroid injection, stent placement, may improve the efficacy of EI.
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Affiliation(s)
- Chengbai Liang
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Jiaxi Lu
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Meixian Le
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
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Tan Y, Lu J, Lv L, Le M, Liu D. Current status of endoscopic submucosal tunnel dissection for treatment of superficial gastrointestinal neoplastic lesions. Expert Rev Gastroenterol Hepatol 2020; 14:453-462. [PMID: 32394748 DOI: 10.1080/17474124.2020.1766967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION With the widespread application of screening endoscopy and development of endoscopy-related instruments, more and more gastrointestinal cancers are detected in an early stage. Endoscopic resection is a preferred method for selected patients with superficial gastrointestinal neoplastic lesions, and endoscopic submucosal dissection (ESD) has become a standard method for its ability to perform en bloc resection regardless of the lesion size. ESD can be performed in a conventional or tunneling way, and the latter is termed endoscopic submucosal tunnel dissection (ESTD). AREA COVERED In the present review, we provided a comprehensive review on ESTD for treatment of superficial gastrointestinal neoplastic lesions. We mainly focus on technical details, safety and efficacy of ESTD for esophageal, gastric and colorectal lesions. The present review is expected to provide tips for operators who are going to perform ESTD. EXPERT OPINION The best indication of ESTD is large superficial esophageal neoplastic lesions (circumferential extent > 1/3 and longitudinal extent > 3 cm). Although ESTD has shown promising primary results for superficial gastric and colorectal neoplastic lesions, it is technically difficult and should be attempted only in experienced hands. Post-treatment stricture is a major concern, and preventive measures are recommended for patients with high risk of post-ESTD stricture.
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Affiliation(s)
- Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Jiaxi Lu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Liang Lv
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Meixian Le
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
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20
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Ohki T, Yamamoto M. Esophageal regenerative therapy using cell sheet technology. Regen Ther 2020; 13:8-17. [PMID: 33490318 PMCID: PMC7794050 DOI: 10.1016/j.reth.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/20/2020] [Accepted: 04/19/2020] [Indexed: 12/13/2022] Open
Abstract
We have been conducting research on esophageal regenerative therapy using cell sheet technology. In particular, in the endoscopic field, we have pushed forward clinical research on endoscopic transplantation of cultured autologous oral mucosal epithelial cell sheets to esophageal ulcer after endoscopic submucosal dissection (ESD). We started research in this direction using animal models in 2004 and performed clinical research in 2012 in collaboration with Nagasaki University and Karolinska Institute. Although in full-circumferential cases it was difficult to prevent esophageal stricture after ESD, there were no complications and stricture could be suppressed. The cell sheet technology is still in its infancy. However, we are convinced that it has a high potential for application in various areas of gastrointestinal science. In this review, we focus on the pre-clinical and clinical trial results obtained and on the theoretical aspects of (1) stricture prevention, (2) esophageal tissue engineering research, and (3) endoscopic transplantation, and review the esophageal regenerative therapy by cell sheet technology.
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Key Words
- CMC, carboxymethyl cellulose
- CPC, cell-processing center
- Cell sheet technology
- EBD, endoscopic balloon dilation
- ECM, extracellular matrix
- EMR, endoscopic mucosal dissection
- ESD, endoscopic submucosal dissection
- Endoscopic submucosal dissection (ESD)
- Endoscopic transplantation
- Esophageal stricture
- GMP, good manufacturing practice
- OMECS, oral mucosal epithelial cell sheet
- PGA, polyglycolic acid
- PIPAAm, poly(N-isopropylacrylamide)
- PVDF, polyvinylidene difluoride
- Regenerative medicine
- SEMS, self-expandable metallic stent
- TAC, triamcinolone
- Tissue-engineered oral mucosal
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Affiliation(s)
- Takeshi Ohki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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