Clin Endosc.  2013 Nov;46(6):643-646.

Intralesional Steroid Injection to Prevent Stricture after Near-Circumferential Endosopic Submucosal Dissection for Superficial Esophageal Cancer

• Lee WJ
• Jung HY
• Kim DH
• Lee JH
• Choi KD
• Song HJ
• Lee GH
• Kim JH

Abstract

Stricture frequently occurs after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma with near- or whole-circumferential mucosal defects, and post-ESD stricture is difficult to treat and usually requires multiple sessions of endoscopic balloon dilatation. Intralesional steroid injection has previously been used to prevent stricture; however, there have been few experiences with this method after near- or whole-circumferential ESD. We present a case of a single session of intralesional steroid injection performed immediately after near-circumferential ESD to prevent post-ESD stricture. After a follow-up period of 6 months, the patient showed good outcome without dysphagia.

Keyword

Injections, intralesional; Esophageal stenosis; Endoscopic submucosal dissection; Esophageal neoplasms

MeSH Terms

Constriction, Pathologic*
Deglutition Disorders
Dilatation
Esophageal Neoplasms*
Esophageal Stenosis
Follow-Up Studies
Humans
Injections, Intralesional

Figure

• 

  Fig. 1 (A) Upper endoscopy with lugol solution reveals an unstained area in the lower esophagus. The superficial esophageal carcinoma involves almost the whole circumference of the esophageal lumen. (B) Circumferential markings are made by a hook knife just outside the lesion. (C) Precutting is made with a hook knife. (D) Near-circumferential endoscopic submucosal dissection is performed. (E) Triamcinolone is injected into the deep submucosa and the superficial proper muscle layer of the ulcer base. (F) The tumor is removed en bloc.

• 

  Fig. 2 (A) Follow-up esophagography 4 weeks later reveals minimal segmental luminal narrowing (arrow) without passage disturbance. (B) Follow-up endoscopy 4 months later shows only a scar (arrow).

Reference

1. Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol. 2005; 3(7):Suppl 1. S67–S70. PMID: 16013002.

2. Ono S, Fujishiro M, Niimi K, et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc. 2009; 70:860–866. PMID: 19577748.

3. Ono S, Fujishiro M, Niimi K, et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy. 2009; 41:661–665. PMID: 19565442.

4. Takahashi H, Arimura Y, Okahara S, et al. Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma. Endoscopy. 2011; 43:184–189. PMID: 21234854.

5. Yamaguchi N, Isomoto H, Nakayama T, et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2011; 73:1115–1121. PMID: 21492854.

6. Hashimoto S, Kobayashi M, Takeuchi M, Sato Y, Narisawa R, Aoyagi Y. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc. 2011; 74:1389–1393. PMID: 22136782.

7. Katada C, Muto M, Manabe T, Boku N, Ohtsu A, Yoshida S. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc. 2003; 57:165–169. PMID: 12556777.

8. Esophageal dilation. Guidelines for clinical application. Gastrointest Endosc. 1991; 37:122–124. PMID: 2004679.

9. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Ichinose M, Omata M. En bloc resection of a large semicircular esophageal cancer by endoscopic submucosal dissection. Surg Laparosc Endosc Percutan Tech. 2006; 16:237–241. PMID: 16921303.

10. Isomoto H, Yamaguchi N, Nakayama T, et al. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. BMC Gastroenterol. 2011; 11:46. PMID: 21542926.

11. Ezoe Y, Muto M, Horimatsu T, et al. Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol. 2011; 45:222–227. PMID: 20861798.

12. Miyashita M, Onda M, Okawa K, et al. Endoscopic dexamethasone injection following balloon dilatation of anastomotic stricture after esophagogastrostomy. Am J Surg. 1997; 174:442–444. PMID: 9337171.

13. Hanaoka N, Ishihara R, Takeuchi Y, et al. Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy. 2012; 44:1007–1011. PMID: 22930171.

14. Roques C, Téot L. The use of corticosteroids to treat keloids: a review. Int J Low Extrem Wounds. 2008; 7:137–145. PMID: 18611924.

15. Rajan E, Gostout C, Feitoza A, et al. Widespread endoscopic mucosal resection of the esophagus with strategies for stricture prevention: a preclinical study. Endoscopy. 2005; 37:1111–1115. PMID: 16281141.