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Predictive factors for esophageal stenosis in patients receiving prophylactic steroid therapy after endoscopic submucosal dissection for esophageal squamous cell carcinoma

Authors :
Junichi Mizuno
Yuji Urabe
Shiro Oka
Hirona Konishi
Kazuki Ishibashi
Motomitsu Fukuhara
Hidenori Tanaka
Akiyoshi Tsuboi
Ken Yamashita
Yuichi Hiyama
Takahiro Kotachi
Hidehiko Takigawa
Ryo Yuge
Toru Hiyama
Shinji Tanaka
Source :
BMC Gastroenterology, Vol 24, Iss 1, Pp 1-8 (2024)
Publication Year :
2024
Publisher :
BMC, 2024.

Abstract

Abstract Background Methods to prevent esophageal stenosis (ES) after endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (ESCC) have received increasing attention. Although steroid administration is a prophylactic treatment, the risk factors for ES during prophylactic steroid therapy remain unknown. Therefore, this study aimed to retrospectively evaluate the risk factors for refractory ES in patients administered prophylactic steroids after ESD for ESCC. Methods Among 795 patients with ESCC (854 lesions), 180 patients (211 lesions) administered local triamcinolone acetonide (TrA) and/or oral prednisolone were recruited for this study. We compared the total number of endoscopic balloon dilatation (EBD) procedures performed for post-ESD ES and clinical findings (tumor size, ESD history or chemoradiation therapy [CRT], entire circumferential resection, muscle layer damage, supplemental oral prednisolone administration, EBD with TrA injection, and additional CRT) between patients with refractory and non-refractory ES. EBD was continued until dysphagia resolved. We categorized cases requiring ≥ 8 EBD procedures as refractory postoperative stenosis and divided the lesions into two groups. Results Multivariate logistic regression analysis revealed that factors such as ESD history, CRT history, tumor size, and entire circumferential resection were independently associated with the development of refractory ES. The withdrawal rates of EBD at 3 years were 96.1% (52/53) and 58.5% (39/59) in the non-refractory and refractory groups, respectively. Conclusions Our data suggest that entire circumferential resection and CRT history are risk factors for refractory post-ESD ES in ESCC, even with prophylactic steroid administration.

Details

Language :
English
ISSN :
1471230X
Volume :
24
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Gastroenterology
Publication Type :
Academic Journal
Accession number :
edsdoj.80f13793252f473dbe2685661d8ebd15
Document Type :
article
Full Text :
https://doi.org/10.1186/s12876-024-03135-9