Premium
Prospective multicenter study of the esophageal triamcinolone acetonide‐filling method in patients with subcircumferential esophageal endoscopic submucosal dissection
Author(s) -
Shibagaki Kotaro,
Yuki Takafumi,
Taniguchi Hideaki,
Aimi Masahito,
Miyaoka Yoichi,
Yuki Mika,
Ishimura Norihisa,
Oshima Naoki,
Mishiro Tsuyoshi,
Tamagawa Yuji,
Mikami Hironobu,
Izumi Daisuke,
Yamashita Noritsugu,
Sato Shuichi,
Ishihara Shunji,
Kinoshita Yoshikazu
Publication year - 2020
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.13496
Subject(s) - medicine , dysphagia , stenosis , endoscopic submucosal dissection , triamcinolone acetonide , endoscope , surgery , esophageal cancer , clinical endpoint , adverse effect , prospective cohort study , esophageal stenosis , incidence (geometry) , esophagus , randomized controlled trial , cancer , physics , optics
Background and Aim The esophageal triamcinolone acetonide ( TA )‐filling method is a novel local approach for stenosis prevention after extensive esophageal endoscopic submucosal dissection ( ESD ). We evaluated this method after subcircumferential ESD . Methods We enrolled 20 patients with esophageal cancer requiring subcircumferential ESD in a prospective multicenter study. Esophageal TA filling was carried out 1 day and 1 week after ESD , with follow‐up endoscopy every 2 weeks. We treated severe stenosis preventing endoscope passage with endoscopic balloon dilatation ( EBD ) and additional TA filling, and mild stenosis allowing endoscope passage with additional TA filling only. Primary endpoint was incidence of severe stenosis; secondary endpoints were total number of EBD , rate of additional TA filling, time to stenosis and complete re‐epithelialization, dysphagia score, and adverse events. Horizontal resection grade was divided into grades 1 (≥ 9/12 and <10/12 of the circumference), 2 (≥ 10/12 and <11/12), and 3 (≥ 11/12 but not circumferential) and analyzed statistically for correlation with endpoints. Results Incidence of severe stenosis was 5.0% (1/20; 0.1–24.8%) and was treated with three EBD . Six patients showed mild stenosis. Additional TA filling was carried out in these seven patients: 0% (0/9) for grade 1 resection, 40% (2/5) for grade 2, and 83% (5/6) for grade 3 ( P < 0.05). Median time to stenosis and re‐epithelialization was 3 and 7 weeks, respectively. Dysphagia score deteriorated in one patient. No adverse events occurred. Conclusions The esophageal TA ‐filling method prevented stenosis after subcircumferential ESD . Grade ≥2 resection showed a high risk for stenosis, but additional TA filling for mild stenosis inhibited stenosis progression ( UMIN 000024384).