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Steroid permeation into the artificial ulcer by combined steroid gel application and balloon dilatation: Prevention of esophageal stricture
Author(s) -
Mori Hirohito,
Rafiq Kazi,
Kobara Hideki,
Fujihara Shintaro,
Nishiyama Noriko,
Oryuu Makoto,
Suzuki Yasuyuki,
Masaki Tsutomu
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12154
Subject(s) - medicine , triamcinolone acetonide , dysphagia , surgery , esophageal stricture , balloon , balloon dilatation , esophageal cancer , endoscopy , steroid , endoscopic submucosal dissection , cancer , hormone
Background and Aim Local steroid injection therapy is effective for preventing esophageal stricture after endoscopic submucosal dissection ( ESD ) but is associated with the risk of puncture‐related complications, such as bleeding. We evaluated the effectiveness of the application of triamcinolone acetonide gel following permeation into a large artificial ESD ulcer by balloon dilatation compared with steroid injection. Methods Forty‐three patients who underwent ESD for early esophageal cancer approved by the institutional ethics committee and provided consent to participate in this prospective study were divided into two groups using a sealed‐envelope randomization method as follows: 23 patients who were treated with local steroid injection and balloon dilatation and 20 patients were treated with steroid application and balloon dilatation. The stricture rate, the number of endoscopic balloon dilatation, and the mean procedure time on postoperative days ( PODs ) 5, 8, 12, 15, 20, 30, and 60 were analyzed. Results No significant difference was found in the stricture rate on PODs 5, 8, 12, 15, 20, 30, and 60 between the two groups. The mean number of endoscopic balloon dilatation procedures performed for treating dysphagia that appeared on or after POD 30 was significantly different between groups ( P = 0.011). The mean procedure time showed no significant difference. Procedure‐related bleeding during the first 30 days was observed more in the local steroid injection group than the gel application group ( P = 0.02). Conclusions Steroid gel application is an effective way for preventing esophageal stricture after ESD and is more effective compared with local injection in terms of prevention of stricture.