Prevention of Stricture Formation After Esophageal Endoscopic Submucosal Dissection

Abstract

Endoscopic balloon dilation (EBD) is usually applied once or twice each week during the early post endoscopic submucosal dissection (ESD) stage after esophageal semicircumferential or circumferential ESD to prevent postoperative stricture formation. However, the long duration before being freed from esophageal strictures imposes a heavy burden on patients. Moreover, perforation of a fibrous stricture is a risk associated with EBD. To overcome these problems, we started to inject a steroid (triamcinolone acetonide ; Kenacort-A, Bristol-Myers Squibb, USA) into an artificial ulcer base after ESD in June 2008. Two or three days after ESD, the steroid (0.2 mL) is injected into the remaining submucosal layer of the post ESD ulcer base, which is then injected with the steroid two to four more times (twice weekly). The steroid must not be injected into the deeper layer of the ulcer base to avoid delayed perforation. Additional EBD was unnecessary in about 80% of the semicircumferential ESD. Less additional EBD was required for circumferential ESD than for EBD alone. Steroid injection therapy is considered to be very effective in preventing postoperative stricture after esophageal ESD.