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Prediction of esophageal stricture in patients given locoregional triamcinolone injections immediately after endoscopic submucosal dissection
Author(s) -
Nagami Yasuaki,
Ominami Masaki,
Shiba Masatsugu,
Sakai Taishi,
Fukunaga Shusei,
Sugimori Satoshi,
Otani Koji,
Hosomi Shuhei,
Tanaka Fumio,
Taira Koichi,
Kamata Noriko,
Yamagami Hirokazu,
Tanigawa Tetsuya,
Watanabe Toshio,
Ishihara Takuma,
Yamamoto Kouji,
Fujiwara Yasuhiro
Publication year - 2018
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12946
Subject(s) - medicine , triamcinolone acetonide , esophageal stricture , endoscopic submucosal dissection , surgery , odds ratio , retrospective cohort study , confidence interval , dissection (medical) , esophagus
Background and Aim Esophageal endoscopic submucosal dissection ( ESD ) to resect widespread lesions has increased the incidence of strictures, and some patients develop strictures despite receiving prophylactic locoregional triamcinolone injections. The present study evaluated the predictive factors for esophageal stricture formation in patients given prophylactic triamcinolone injections after ESD . Methods This was a retrospective observational study. Of 552 consecutive patients who underwent ESD , those who received prophylactic triamcinolone injections immediately after ESD were enrolled. Primary outcome was predictive factors for esophageal stricture formation in patients given prophylactic triamcinolone injections. Results We evaluated 101 en bloc resections involving 144 lesions in 96 patients. Strictures occurred following 17 (16.8%) resections. Wider circumferential mucosal defect (odds ratio [ OR ] 2.42, 95% confidence interval [ CI ]: 1.01–5.80; P = 0.048) was an independent predictive factor for stricture development. Cut‐off value associated with stricture formation was five‐sixths of the circumferential mucosal defect. Propensity analysis determined that frequency of esophageal strictures increased in patients with circumferential mucosal defects of more than five‐sixths compared with those less than five‐sixths ( OR = 5.70, 95% CI : 1.61–20.18; P = 0.007). Conclusion Resections involving circumferential mucosal defects of more than five‐sixths increased the likelihood of stricture formation in patients given prophylactic locoregional triamcinolone injections after esophageal ESD .