Clin Endosc.  2022 Jul;55(4):520-524. 10.5946/ce.2021.262.

Intralesional steroid infusion using a spray tube to prevent stenosis after endoscopic submucosal dissection of esophageal cancer

Affiliations
  • 1Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
  • 2Department of Gastroenterology and Hepatology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
  • 3Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan

Abstract

Background/Aims
Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety.
Methods
Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment.
Results
Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed.
Conclusions
Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis Clinical trial number (UMIN000037567).

Keyword

Endoscopic submucosal dissection; Intralesional steroid infusion; Spray tube; Stenosis; Superficial esophageal cancer

Figure

  • Fig. 1. Spray tube (fine jet spraying type; Top Co., Tokyo, Japan).

  • Fig. 2. (A) A patient with early esophageal cancer in the upper esophagus (patient no. 22 in Table 2). (B) Sub-circumferential resection was performed by endoscopic submucosal dissection. (C) Immediately after resection of the lesion, intralesional steroid infusion using a spray tube was performed. (D) The resected surface was completely re-epithelialized without stenosis 2 months after endoscopic submucosal dissection.


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