scholarly journals Effectiveness of topical budesonide in preventing esophageal strictures after endoscopic resection of esophageal cancer

2020 ◽  
Vol 08 (12) ◽  
pp. E1795-E1803
Author(s):  
Steffi Elisabeth Maria van de Ven ◽  
Manon J.B.L. Snijders ◽  
Marco J. Bruno ◽  
Arjun Dave Koch
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Resection ◽  
Esophageal Stricture ◽  
Oral Treatment ◽  
Preventive Treatment ◽  
Control Groups ◽  
Early Esophageal Cancer ◽  
Mucosal Defect ◽  
Stricture Rate ◽  
Esophageal Strictures

Abstract Background and study aims A disadvantage of endoscopic resection (ER) of early esophageal cancer (EC) is the high stricture rate after resection. A risk factor for stricture development is a mucosal defect after ER of ≥ 75 % of the esophageal circumference. Stricture rates up to 94 % have been reported in these patients. The aim of this study was to investigate the effectiveness of oral treatment with topical budesonide for stricture prevention after ER of early EC. Patients and methods We performed a retrospective analysis of a prospective cohort study of patients who received topical budesonide after ER of EC between March 2015 and April 2020. The primary endpoint was the esophageal stricture rate after ER. Stricture rates of our cohort were compared with stricture rates of control groups in the literature. Results In total, 42 patients were treated with ER and topical budesonide. A total of 18 of 42 patients (44.9 %) developed a stricture. The pooled stricture rate of control groups in the literature was 75.3 % (95 % CI 68.8 %-81.9 %). Control groups consisted of patients with esophageal squamous cell carcinoma with a mucosal defect after ER of ≥ 75 % of the esophageal circumference. Comparable patients of our cohort had a lower stricture rate (47.8 % vs. 75.3 %, P = 0.007). Conclusions Topical budesonide therapy after ER for EC seems to be a safe and effective method in preventing strictures. The stricture rate after budesonide treatment is lower compared to the stricture rate of patients who did not receive a preventive treatment after ER reported in the literature.

scholarly journals Advances in the prevention and treatment of esophageal stricture after endoscopic submucosal dissection of early esophageal cancer

2020 ◽  
Vol 8 (3) ◽  
pp. 135-145
Author(s):  
Yue Zhang ◽  
Baozhen Zhang ◽  
Yidan Wang ◽  
Jingjing Zhang ◽  
Yufan Wu ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Esophageal Stricture ◽  
Standard Treatment ◽  
Early Esophageal Cancer ◽  
Submucosal Dissection ◽  
Treatment And Prevention ◽  
Global Issue ◽  
Esophageal Strictures ◽  
Standard Treatment Regimen

AbstractEndoscopic submucosal dissection (ESD) has become the main treatment for early esophageal cancer. While treating the disease, ESD may also cause postoperative esophageal stricture, which is a global issue that needs resolution. Various methods have been applied to resolve the problem, such as mechanical dilatation, glucocorticoids, anti-scarring drugs, and regenerative medicine; however, no standard treatment regimen exists. This article describes and evaluates the strengths and limitations of new and promising potential strategies for the treatment and prevention of esophageal strictures.

scholarly journals Mid- and long-term outcomes of endoscopic resection for submucosal esophageal cancer types pT1b-SM1 and pT1b-SM2

2019 ◽  
Vol 07 (06) ◽  
pp. E733-E742 ◽  
Author(s):  
Andres Mora ◽  
Kenro Kawada ◽  
Yasuaki Nakajima ◽  
Takuya Okada ◽  
Yutaka Tokairin ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Resection ◽  
Survival Rates ◽  
Early Esophageal Cancer ◽  
En Bloc ◽  
Term Survival ◽  
Long Term Survival ◽  
Submucosal Tumors ◽  
Submucosal Cancer

Abstract Background and study aims Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are promising therapeutic options for early esophageal cancer (EC). The factors that can affect mid- and long-term survival in patients with submucosal EC (SM1 and SM2) have not been described in the literature. We aim to describe clinicopathological outcomes and factors that can affect the mid- and long-term survival in patients with resected submucosal tumors. Patients and methods We performed a retrospective analysis of patients who underwent endoscopic resection (ER) for submucosal tumors over a 20-year period. The final study population included 119 cases with 137 lesions. Information was collected according to the Japanese Classification of Esophageal Cancer 11-edition and factors affecting survival for 2 and 5 years after ER were analyzed. Results EMR was performed in 99 cases (72.3 %), ESD in 38 cases (27.7 %). There were no significant complications. Two- and 5-year survival rates were 91 % and 82 %, respectively. Mean age was 67.22 years (± 9.49 years), mortality caused by EC occurred in 13 cases (11 %). Factors that had a significant impact on long-term survival were age > 65 years (P = 0.0026), number of resected specimens (P = 0.0031), presence of another progressive disease (not EC) (P ≤ 0.001), recurrence (P = 0.0002), and relation between histopathological positive vertical margin and recurrence (P = 0.0112). Conclusions ER is viable treatment for esophageal submucosal cancer, selection between ESD/EMR can depend on tumor size and patient condition, and en bloc ER is the recommended technique for submucosal tumors. Long-term survival factors were identified.

Early esophageal cancer with epidermization diagnosed and treated with endoscopic resection

2017 ◽  
Vol 11 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Satoshi Yamanouchi ◽  
Yukiko Sako ◽  
Shinsuke Suemitsu ◽  
Kousuke Tsukano ◽  
Satoshi Kotani ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Resection ◽  
Early Esophageal Cancer

scholarly journals Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer

2019 ◽  
Vol 12 ◽  
pp. 175628481989255 ◽  
Author(s):  
Solène Dermine ◽  
Mahaut Leconte ◽  
Sarah Leblanc ◽  
Bertrand Dousset ◽  
Benoit Terris ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Endoscopic Resection ◽  
Lymph Node Metastases ◽  
Early Esophageal Cancer ◽  
Cancer Specific Survival ◽  
Node Metastases ◽  
Disease Free

Background: Current guidelines recommend performing esophagectomy after endoscopic resection for early esophageal cancer when the risk of lymph node metastasis or residual cancer is found to be significant and endoscopic treatment is therefore noncurative. Our aim was to assess the safety and oncological outcomes of esophagogastric resection in this specific clinical setting. Patients and methods: A retrospective review from 2012 to 2018 was performed at four tertiary referral centers. All patients had a noncurative endoscopic resection of a clinical T1 esophageal cancer, followed by esophagectomy. Outcome measures were the rates of T0N0 specimens, overall survival, disease-free and cancer-specific survival, postoperative morbidity and mortality. Results: A total of 30 patients (13 with squamous cell carcinoma and 17 with adenocarcinoma) were included. The reasons for noncurative endoscopic resection were: positive vertical margins ( n = 12), squamous cell carcinoma with muscularis mucosae or submucosal layer invasion ( n = 3 and 9), adenocarcinoma with deep submucosal invasion ( n = 11), poorly differentiated tumor ( n = 6) and lymphovascular invasion ( n = 6). Overall, 63% of the esophagi were T0N0: most residual lesions were T1a metachronous lesions, and four (13%) patients had advanced pT status ( n = 3) or lymph node metastases ( n = 2). Overall survival, disease-free survival and cancer-specific survival were 83%, 75%, and 90% respectively. A total of 43% of patients had severe postoperative complications, and postoperative mortality was 7%. Conclusion: In this cohort, esophagectomy allowed the resection of residual advanced cancer or lymph node metastases in 13% of cases, at the cost of 43% severe morbidity and 7% mortality. Therefore, the possibility of close follow up needs to be balanced with a highly morbid surgical management in these patients.

Tu1207 Association Between Macrocytosis and the Field Cancerization Phenomenon After Curative Endoscopic Resection in Men With Early Esophageal Cancer

2016 ◽  
Vol 83 (5) ◽  
pp. AB575-AB576
Author(s):  
Chikatoshi Katada ◽  
Tetsuji Yokoyama ◽  
Tomonori Yano ◽  
Kazuhiro Kaneko ◽  
Ichiro Oda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Resection ◽  
Field Cancerization ◽  
Early Esophageal Cancer

scholarly journals Management of esophageal strictures after endoscopic resection for early neoplasia

2021 ◽  
Vol 14 ◽  
pp. 175628482098529
Author(s):  
Einas Abou Ali ◽  
Arthur Belle ◽  
Rachel Hallit ◽  
Benoit Terris ◽  
Frédéric Beuvon ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Endoscopic Treatment ◽  
Esophageal Stricture ◽  
Rare Event ◽  
Median Number ◽  
High Rate ◽  
Endoscopic Dilatation ◽  
Tertiary Referral Center ◽  
Esophageal Neoplasia ◽  
Esophageal Strictures

Background: Endoscopic resection of extensive esophageal neoplastic lesions is associated with a high rate of esophageal stricture. Most studies have focused on the risk factors for post-endoscopic esophageal stricture, but data on the therapeutic management of these strictures are scarce. Our aim is to describe the management of esophageal strictures following endoscopic resection for early esophageal neoplasia. Methods: We included all patients with an endoscopic resection for early esophageal neoplasia followed by endoscopic dilatation at a tertiary referral center. We recorded the demographic, endoscopic, and histological characteristics, and the outcomes of the treatment of the strictures. Results: Between January 2010 and December 2019, we performed 166 endoscopic mucosal resections and 261 endoscopic submucosal dissections for early esophageal neoplasia, and 34 (8.0%) patients developed an esophageal stricture requiring endoscopic treatment. The indication for endoscopic resection was Barrett’s neoplasia in 15/34 (44.1%) cases and squamous cell neoplasia (SCN) in 19/34 (55.9%) cases. The median [(interquartile range) (IQR)] number of endoscopic dilatations was 2.5 (2.0–4.0). Nine of 34 (26.5%) patients required only one dilatation, and 22/34 (65%) had complete dysphagia relief following three endoscopic treatment sessions. The median number of dilatations was significantly higher for SCN [3.0 (2–7); range 1–17; p = 0.02], and in the case of circumferential resection [4.0 (3.0–7.0); p = 0.03]. Endoscopic dilatation allowed a sustained dysphagia relief in 33/34 (97.0%) patients after a mean follow-up of 25.3 ± 22 months. Conclusion: Refractory post-endoscopic esophageal stricture is a rare event. After a median of 2.5 endoscopic dilatations, 97.0% of patients were permanently relieved of dysphagia. Circumferential endoscopic esophageal resections should be considered when indicated.

scholarly journals Stenting to prevent esophageal stricture after circumferential endoscopic submucosal dissection: an experimental study

2020 ◽  
Vol 08 (11) ◽  
pp. E1698-E1706
Author(s):  
Jan Martinek ◽  
Radek Dolezel ◽  
Bara Walterova ◽  
Marek Kollar ◽  
Stefan Juhas ◽  
...  
Keyword(s):  
Experimental Study ◽  
Esophageal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Treatment Option ◽  
Esophageal Stricture ◽  
Drug Eluting Stent ◽  
Early Esophageal Cancer ◽  
Major Drawback ◽  
Biodegradable Stent ◽  
Drug Eluting

Abstract Background and study aims Circular ESD (CESD) is a treatment option for patients with extensive early esophageal cancer. Its major drawback is the development of a stricture. Stenting may represent an attractive prevention strategy. We designed an experimental study to assess the effect of stents covered with acellular biomatrix (AB) and a drug-eluting stent. Materials and methods Thirty-five 35 pigs underwent CESD and were randomized into six groups: G1 (control), G2 (SEMS), G3 (SEMS + AB), G4 (SEMS + AB + steroid-eluting layer), G5 (biodegradable stent [BD]), G6 (BD + AB). SEMS were placed alongside the post-CESD defect, fixed and removed after 21 days. The main outcomes were stricture development, severity, and histopathology. Results Pigs with BD stents (G5, 6) experienced severe inflammation and hypergranulation without biodegradation, therefore, these groups were closed prematurely. Significant strictures developed in 29 of 30 pigs (96.7 %). The most severe stricture developed in G2 and G4 (narrowest diameter (mm) 8.5 ± 3, 3 (G2) and 8.6 ± 2.1 (G4) vs. 17 ± 7.3 (G1) and 13.5 ± 8.3 (G3); P < 0.01. Signs of re-epithelization were present in 67 % and 71 % in G1 and G2 and in 100 % in G3 and G4. The most robust re-epithelization layer was present in G4. The inflammation was the most severe in G1 (mean score 2.3) and least severe in G4 (0.4). Conclusions Stenting did not effectively prevent development of post-CESD esophageal stricture. SEMS with AB resulted in improved re-epithelization and decreased stricture severity. Steroid-eluting SEMS suppressed inflammation. BD stents seem inappropriate for this indication.

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