Prevention of Stricture Formation After Esophageal Endoscopic Submucosal Dissection

2015 ◽  
pp. 131-140
Author(s):  
Manabu Takeuchi
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Stricture Formation ◽  
Submucosal Dissection

PS02.035: CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSAL DISSECTION OF A LARGE SUPERFICIAL OESOPHAGUS SQUAMOUS CELL CANCER WITHOUT STRICTURES ON FOLLOW-UP

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 129-130
Author(s):  
Francisco Baldaque-Silva ◽  
Magnus Konradsson ◽  
Naning Wang ◽  
Masami Omae
Keyword(s):  
Hyaluronic Acid ◽  
Endoscopic Submucosal Dissection ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
High Volume ◽  
Stricture Formation ◽  
Submucosal Dissection ◽  
Oral Steroids

Abstract Description The optimal treatment for oesophageal superficial squamous cell cancer (SCC) is end bloc resection, that in large lesions is only possible with endoscopic submucosal dissection (ESD). Resections larger than 3cm, in the upper esophagus and encompassing more than 3/4 of the luminal circumference, are associated with high stricture rate. That risk is virtually 100% in cases of circumferential ESD. High focus had been given to preventive measurements such as steroids injection, oral steroids or cell sheet transplantation. Usually highly osmotic substances such as Glicerol ® are used for subepitelial lifting. Hyaluronic acid has high viscosity and anti-inflammatory proprieties, that due to its high cost is not widely used in ESD or is used in low concentration formulas and low volume. We report a case of a 7.5 cm long circumferential oesophageal ESD performed with injection of a high volume and concentration of hyaluronic acid that was not associated with stricture in the follow-up. A 73 years-old male patient was referred to our clinic due to the presence of a long superficial lesion and biopsies positive for SCC. We performed chromoendoscopy with lugol that revealed the presence of a ca 6cm long Paris IIa-b, circumferential SCC in the middle esophagus with ‘Tatami-no-me ‘and ‘pink-color’ signs, without ulcers or other endoscopic signs of deep invasion. The PET-CT was negative for metastasis. After multidisciplinary conference and patient's consent an ESD was performed under full narcosis using Dualknife ® and hyaluronic acid for subepitelial injection. A 7.5 cm circumferential ESD specimen was resected and the patient was discharged at day 3 without complications under proton pump Inhibitors and a step-down dose of 30mg/d of oral prednisolone. The pathological result revealed R0 resection of a SCC with invasion of the superficial muscularis mucosae (T1a) and no lymphovascular engagement. The follow-up at 2, 5, 8 weeks and 6, 9 and 12 months revealed the absence of stricture. There was no cancer recurrence in the last follow-up (1 year). Long circumferential ESD of oesophageal SCC is possible with curative intent. The combination of PPI, oral steroids and high volume/concentration of hyaluronic acid, avoided stricture formation in this case. Disclosure All authors have declared no conflicts of interest.

scholarly journals Evaluating the effect of injecting triamcinolone acetonide in two sessions for preventing esophageal stricture after endoscopic submucosal dissection

2019 ◽  
Vol 07 (06) ◽  
pp. E764-E770 ◽  
Author(s):  
Satoru Hashimoto ◽  
Ken-ichi Mizuno ◽  
Kazuya Takahashi ◽  
Hiroki Sato ◽  
Junji Yokoyama ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Triamcinolone Acetonide ◽  
Esophageal Stricture ◽  
Control Group ◽  
Study Group ◽  
Stricture Formation ◽  
Endoscopic Injection ◽  
Submucosal Dissection ◽  
Stricture Rate ◽  
Significant Difference

Abstract Background and study aims Several previous reports indicate that endoscopic injection of triamcinolone acetonide (TA) after widespread endoscopic submucosal dissection (ESD) is effective for preventing esophageal stricture. We investigated the efficacy of injecting TA in two sessions for preventing stricture formation post-ESD. Patients and methods Sixty-six consecutive patients with widespread mucosal defects that affected more than three-fourths of the circumference of the esophagus were included. The study group (n = 40) received TA injections over two sessions: immediately after and 14 days after ESD. The control group (n = 26) did not receive a TA injection. This study was performed retrospectively against historical controls. The primary endpoint of this study was frequency of stricture after TA injection. The secondary endpoint was number of required endoscopic balloon dilations (EBDs) after TA injection. Results The post-ESD stricture rate among patients who had subcircumferential mucosal defects was 45.7 % in the study group (16/35 patients), which was significantly lower than the rate of 73.9 % in the control group (17/23 patients; P = 0.031). The number of EBD procedures required was significantly lower in the study group (median 0, range 0 – 7) than in the control group (median 4, range 0 – 20; P < 0.001). There was no significant difference between the study and control groups among the patients who had full circumferential mucosal defects. Conclusion This study showed that performing two sessions of TA injection is an effective and safe treatment for prevention of esophageal stricture following subcircumferential ESD.

Endoscopic submucosal dissection using a novel endoscopic articulating knife for clinical staging of early esophageal neoplasia.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 114-114
Author(s):  
Juan Genere ◽  
Harshith Priyan ◽  
Kenneth Wang
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Narrow Band Imaging ◽  
Clinical Stage ◽  
Clinical Staging ◽  
Blue Dye ◽  
Stricture Formation ◽  
Early Esophageal Cancer ◽  
Esophageal Neoplasia ◽  
Submucosal Dissection

114 Background: Clinical staging of early esophageal neoplasia traditionally involves histological confirmation and imaging with endoscopic ultrasound (EUS), CT, and PET which have low sensitivity and specificity for staging esophageal cancer (EC). Endoscopic submucosal dissection (ESD) therapy is traditionally used for treatment, but not diagnosis as it is felt to be technically challenging and have a high risk for complications. We applied a new articulating endoscopic knife that permits safe ESD (ESD-CC) to evaluate early neoplasia with potential curative resection. Methods: We performed a retrospective study of patients undergoing ESD to stage or treat suspected early EC (cT1-T2). Clinical stage was done by EUS, CT, and PET. Two expert GI pathologists reviewed all histology. Lesions were examined with high resolution white light endoscopy and narrow band imaging. ESD was done with 1:200,000 epinephrine and methylene blue dye injection for lifting and staining the submucosal space. A 5mm, scissors-like articulated knife was used to perform ESD and hemostasis. Complications during post-ESD observation or follow-up were recorded. Results: A total of 35 patients who underwent ESD-CC were included with median age 70 (IQR 12), 26 males (74%), and followed for a median 3.4 months (IQR 6.4). This group consisted of 32 potential adenocarcinomas and 3 squamous cell cancers. The clinical Pre-ESD diagnoses were cT1 EC (24, 69%) and suspected EC in Barrett’s esophagus (BE) (11, 31%). The cT1 EC cases had ESD staged at least T1b (5, 21%), T1a (11, 46%), EC in situ (1, 4%), and dysplastic BE (7, 29%). The suspected EC cases had ESD staged at least T1b (1, 9%), T1a (2, 18%), and DBE (8, 73%). ESD-CC up-staged 4 (11%), down-staged 10 (29%), and confirmed prior diagnosis in 21 (60%). No complications including bleeding, perforation, or stricture formation regardless of size of ESD, age of patient, or co-morbidities. Conclusions: Staging of early esophageal cancer can be improved using ESD with an articulating knife, without increase in complications. ESD may be used as a staging modality in early esophageal cancer.

The safety and efficacy of radiofrequency ablation following endoscopic submucosal dissection for Barrett's neoplasia

2017 ◽  
Vol 31 (3) ◽  
Author(s):  
S Subramaniam ◽  
K Kandiah ◽  
F Chedgy ◽  
P Meredith ◽  
G Longcroft-Wheaton ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
Stricture Formation ◽  
Complication Rates ◽  
Safety And Efficacy ◽  
Submucosal Dissection ◽  
Increased Risk ◽  
Tertiary Center ◽  
Significant Difference

SUMMARY The current standard of treating early Barrett's neoplasia is resection of visible lesions using endoscopic mucosal resection (EMR) followed by ablative therapy to the Barrett's segment. There is increasing evidence to support the use of endoscopic submucosal dissection (ESD) where en-bloc resection and lower recurrence rates may be achieved. However, ESD is associated with deep submucosal dissection when compared to EMR. This may increase the risk of complications including stricture formation with subsequent radiofrequency ablation (RFA) therapy. The aim of this study is to compare the safety and efficacy of RFA following EMR and ESD as well as when RFA was used without prior endoscopic resection. The primary outcome measure was complication rates. Clearance of dysplasia (CRD) and clearance of intestinal metaplasia (CRIM) were secondary outcomes. A retrospective analysis of a cohort of 91 patients referred for RFA from a single academic tertiary center was performed. The choice of endoscopic resection method was tailored according to the lesion type and morphology. Focal and circumferential ablation was performed after initial follow up endoscopy postresection. Patients proceeded straight to RFA in the absence of any visible lesions. In this study, the ESD group had a higher proportion of cancers compared to the EMR cohort (74.1% vs. 30.2%, P < 0.01) prior to RFA. All complications post RFA occurred in the groups with previous endoscopic resection. There was no significant difference in the total complication rate (7.4% vs. 9.3%, P = 0.78) and stricture formation rate (3.7% vs. 9.3%, P = 0.38) between the ESD and EMR groups. CRD was achieved in 96.3% in the ESD group, 88.4% in the EMR group, and all patients in the RFA alone group. CRIM rates were similar in the EMR and ESD groups (81.4% vs. 85.2%) but higher in the RFA alone group (90.5%). In conclusion, RFA following ESD is very effective and not associated with an increased risk of complications compared to EMR. This supports the application of RFA in the treatment algorithm of patients undergoing ESD for Barrett's neoplasia.

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