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Management of complications associated with endoscopic submucosal dissection/ endoscopic mucosal resection for esophageal cancer
Author(s) -
Isomoto Hajime,
Yamaguchi Naoyuki,
Minami Hitomi,
Nakao Kazuhiko
Publication year - 2013
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/j.1443-1661.2012.01388.x
Subject(s) - medicine , esophageal stricture , endoscopic mucosal resection , perforation , esophageal cancer , surgery , esophagus , endoscopic submucosal dissection , balloon dilation , endoscopy , complication , cancer , balloon , materials science , punching , metallurgy
Endoscopic resection of early esophageal cancer ( EEC ) is an established therapy in J apan and is increasingly becoming accepted and used regularly in other countries. Endoscopic submucosal dissection ( ESD ), an application of conventional endoscopic mucosal resection ( EMR ), has been developed to allow the resection of larger lesions in an en bloc manner; the earliest results so far have been promising even in EEC . ESD allows precise assessment of the histopathological curability of resected specimens, reducing local recurrence. However, ESD has relatively high complication rates; notification of perforation risk is essential especially in the esophagus. Bleeding during ESD can be managed by endoscopic closure with endoclips, and delayed bleeding is rare. Esophageal stricture following semicircular or complete circular esophageal ESD was relatively frequent even when treated by multiple pre‐emptive endoscopic balloon dilation. Endoscopic triamcinolone injection, temporal stenting and innovative transplantation of autologous tissue‐engineered epithelial cell sheets have shown promising results for the prevention of luminal stricture following semicircular esophageal ESD . In cases of circumferential ESD , however, giving oral prednisolone can offer a unique treatment option for the prevention of intractable post‐procedural stricture of the esophagus.