Intensive triamcinolone acetonide injection regimen can highly prevent stricture after extensive esophageal endoscopic submucosal dissection

Abstract

Background

This study aimed to investigate the utility of intensive triamcinolone acetonide (TA) injections after extensive esophageal endoscopic submucosal dissection (ESD).

Methods

This retrospective study included 27 lesions in 27 consecutive patients who underwent ESD (ulcers encompassing ≥3/4 of the esophageal circumference) and received TA injections without oral steroid administration. Groups A and B included patients undergoing ESD with and without complete circumferential resection, respectively. All patients received TA injections (100 mg/session) immediately after ESD. In Group A, weekly based TA injections were performed until near-complete ulcer epithelialization. In Group B, patients did not receive additional injections or received weekly or biweekly TA injections. The primary outcome was stricture rate, and the secondary outcomes were the proportion of patients requiring endoscopic balloon dilation (EBD) and the number of TA injections.

Results

Group A included 7 lesions, and Group B included 20 lesions. The median (range) tumor lengths were 40 (30–90) and 45 (30–110) mm in Groups A and B, respectively. In Group A, the median circumferential resection diameter was 40 (20–80) mm. The stricture rate and the proportion of patients requiring EBD were 0 (0%) in Group A and 1 (5.0%) in Group B. The number of TA injection sessions was significantly higher in Group A than in Group B (8 [5–25] vs 1.5 [1–3]; p < 0.001).

Conclusions

Intensive weekly or biweekly based TA injections might aid in preventing post-ESD stricture and the need for EBD in patients undergoing extensive resection involving the entire esophageal circumference.

Keywords:

• Esophagus
• endoscopic submucosal dissection
• stricture
• triamcinolone
• injection

Acknowledgments

The authors would like to thank the staff of the Endoscopy Center of Chiba University Hospital for providing technical assistance and helping in the documentation used in this study.

Compliance with ethical standards

This study was conducted in accordance with the e ethical guidelines of the 1975 Declaration of Helsinki (6th revision, 2008). Patients’ data were coded, and the anonymity of patients was guaranteed. The study protocol was reviewed and approved by the Ethics Review Committee of Chiba University Graduate School of Medicine (No3986).

Author contributions

Designed the study, conducted the procedure, collected, analyzed, and interpreted data, wrote the manuscript: KO, TM, NA; assisted in conducting the procedure and collecting data: ST, RH, CG, AK, MS, TK, YO, TT, KS; conducting pathological diagnosis: KM、JII; assisted in interpreting data and writing the manuscript: JK, NK. All authors approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.