Steroid injection and polyglycolic acid shielding to prevent stricture after esophageal endoscopic submucosal dissection: a retrospective comparative analysis (with video).
Aged
Aged, 80 and over
Biocompatible Materials
Carcinoma, Squamous Cell
/ surgery
Constriction, Pathologic
/ etiology
Endoscopic Mucosal Resection
/ adverse effects
Esophageal Neoplasms
/ surgery
Esophageal Stenosis
/ etiology
Female
Fibrin Tissue Adhesive
/ administration & dosage
Glucocorticoids
/ administration & dosage
Humans
Injections
Male
Middle Aged
Polyglycolic Acid
/ administration & dosage
Polymers
/ administration & dosage
Retrospective Studies
Triamcinolone
/ administration & dosage
Journal
Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
20
01
2020
accepted:
18
04
2020
pubmed:
8
5
2020
medline:
20
3
2021
entrez:
8
5
2020
Statut:
ppublish
Résumé
Postoperative stricture after expansive esophageal endoscopic submucosal dissection (ESD) is a severe adverse event. Previous single-arm reports have suggested that polyglycolic acid (PGA) shielding may prevent stricture. This study was performed to assess the efficacy of this method through a comparative analysis. This is a retrospective analysis of 500 consecutive cases of esophageal ESD performed between 2002 and 2018 at the University of Tokyo Hospital. After 2013, patients with a diagnosis of superficial esophageal carcinoma covering more than half of the esophageal circumference underwent preventive treatment with either PGA shielding or steroid injection + PGA shielding after ESD. The efficacy of these methods for preventing post-ESD stricture was assessed through multivariable logistic regression analysis. The risk of postoperative stricture was especially high in the cervical esophagus (odds ratio [OR], 4.60; 95% confidence interval [CI], 0.65-61.09) and after total circumferential resection (OR, 3.58×10 The combination of steroid injection and PGA shielding is effective for preventing post-ESD stricture. There is a need for even more effective methods for cervical esophageal cancer and complete circumferential resection.
Sections du résumé
BACKGROUND AND AIMS
Postoperative stricture after expansive esophageal endoscopic submucosal dissection (ESD) is a severe adverse event. Previous single-arm reports have suggested that polyglycolic acid (PGA) shielding may prevent stricture. This study was performed to assess the efficacy of this method through a comparative analysis.
METHODS
This is a retrospective analysis of 500 consecutive cases of esophageal ESD performed between 2002 and 2018 at the University of Tokyo Hospital. After 2013, patients with a diagnosis of superficial esophageal carcinoma covering more than half of the esophageal circumference underwent preventive treatment with either PGA shielding or steroid injection + PGA shielding after ESD. The efficacy of these methods for preventing post-ESD stricture was assessed through multivariable logistic regression analysis.
RESULTS
The risk of postoperative stricture was especially high in the cervical esophagus (odds ratio [OR], 4.60; 95% confidence interval [CI], 0.65-61.09) and after total circumferential resection (OR, 3.58×10
CONCLUSION
The combination of steroid injection and PGA shielding is effective for preventing post-ESD stricture. There is a need for even more effective methods for cervical esophageal cancer and complete circumferential resection.
Identifiants
pubmed: 32376336
pii: S0016-5107(20)34270-X
doi: 10.1016/j.gie.2020.04.070
pii:
doi:
Substances chimiques
Biocompatible Materials
0
Fibrin Tissue Adhesive
0
Glucocorticoids
0
Polymers
0
Triamcinolone
1ZK20VI6TY
Polyglycolic Acid
26009-03-0
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1176-1186.e1Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.