Prophylactic steroid administration for strictures after endoscopic resection of large superficial esophageal squamous cell carcinoma
Background and study aims: One of the major complications after endoscopic resection (ER) for large superficial esophageal squamous cell carcinoma (ESCC) is benign esophageal stricture, which can reduce quality of life even if ESCC achieves...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2016-11-01
|
| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-118291 |
| _version_ | 1818426540299386880 |
|---|---|
| author | Tomohiro Kadota Tomonori Yano Tomoji Kato Maomi Imajoh Masaaki Noguchi Hiroyuki Morimoto Shozo Osera Yusuke Yoda Yasuhiro Oono Hiroaki Ikematsu Atsushi Ohtsu Kazuhiro Kaneko |
| author_facet | Tomohiro Kadota Tomonori Yano Tomoji Kato Maomi Imajoh Masaaki Noguchi Hiroyuki Morimoto Shozo Osera Yusuke Yoda Yasuhiro Oono Hiroaki Ikematsu Atsushi Ohtsu Kazuhiro Kaneko |
| author_sort | Tomohiro Kadota |
| collection | DOAJ |
| description | Background and study aims: One of the major complications after endoscopic
resection (ER) for large superficial esophageal squamous cell carcinoma (ESCC)
is benign esophageal stricture, which can reduce quality of life even if ESCC
achieves a cure without organ resection. Recently, steroid administration has
been reported as a prophylactic treatment to prevent esophageal strictures. This
retrospective study evaluated the stricture rate according to the different
width of mucosal defects due to ER and compared it to that seen with
prophylactic steroid administration.
Patients and methods: Between June 2007 and December 2013, we enrolled
patients with ESCC who had 3/4 or larger circumferential mucosal defects due to
ER. In December 2009, steroid injections (triamcinolone acetonide 50 mg) into
the ulcer bed due to ER were introduced. Beginning in November 2012, we
commenced oral steroid administration (prednisolone 30 mg/day, tapered gradually
for 8 weeks) in addition to steroid injection. Patients were classified into 3
groups according to the width of mucosal defect after ER (Group A, ≥ 3/4 and
< 7/8; Group B, ≥ 7/8 and less than the entire circumference; and Group C,
the entire circumference). We retrospectively evaluated the stricture rate by
comparing no treatment, steroid injection, or steroid injection followed by oral
steroid according to the width of mucosal defect.
Results: A total of 115 patients met the selection criteria. In Group B,
no treatment had a significantly higher stricture rate (100 %, vs. steroid
injection: 56 % P = 0.015; vs steroid injection followed by oral steroid:
20 % P < 0.001). Conversely, in Group C, the stricture rate was high,
regardless of treatment (no treatment: 100 %; steroid injection: 100 %; steroid
injection followed by oral steroid: 71 %).
Conclusions: Although prophylactic steroid administration is effective to
prevent strictures for 7/8 circumference or larger mucosal defects, it is
ineffective for whole-circumference defects. Further investigation is
required. |
| first_indexed | 2024-12-14T14:31:27Z |
| format | Article |
| id | doaj.art-fb348ae2ea334fc280364888c52d5966 |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-14T14:31:27Z |
| publishDate | 2016-11-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-fb348ae2ea334fc280364888c52d59662022-12-21T22:57:47ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362016-11-010412E1267E127410.1055/s-0042-118291Prophylactic steroid administration for strictures after endoscopic resection of large superficial esophageal squamous cell carcinomaTomohiro Kadota0Tomonori Yano1Tomoji Kato2Maomi Imajoh3Masaaki Noguchi4Hiroyuki Morimoto5Shozo Osera6Yusuke Yoda7Yasuhiro Oono8Hiroaki Ikematsu9Atsushi Ohtsu10Kazuhiro Kaneko11Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanCourse of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, JapanDepartment of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, JapanBackground and study aims: One of the major complications after endoscopic resection (ER) for large superficial esophageal squamous cell carcinoma (ESCC) is benign esophageal stricture, which can reduce quality of life even if ESCC achieves a cure without organ resection. Recently, steroid administration has been reported as a prophylactic treatment to prevent esophageal strictures. This retrospective study evaluated the stricture rate according to the different width of mucosal defects due to ER and compared it to that seen with prophylactic steroid administration. Patients and methods: Between June 2007 and December 2013, we enrolled patients with ESCC who had 3/4 or larger circumferential mucosal defects due to ER. In December 2009, steroid injections (triamcinolone acetonide 50 mg) into the ulcer bed due to ER were introduced. Beginning in November 2012, we commenced oral steroid administration (prednisolone 30 mg/day, tapered gradually for 8 weeks) in addition to steroid injection. Patients were classified into 3 groups according to the width of mucosal defect after ER (Group A, ≥ 3/4 and < 7/8; Group B, ≥ 7/8 and less than the entire circumference; and Group C, the entire circumference). We retrospectively evaluated the stricture rate by comparing no treatment, steroid injection, or steroid injection followed by oral steroid according to the width of mucosal defect. Results: A total of 115 patients met the selection criteria. In Group B, no treatment had a significantly higher stricture rate (100 %, vs. steroid injection: 56 % P = 0.015; vs steroid injection followed by oral steroid: 20 % P < 0.001). Conversely, in Group C, the stricture rate was high, regardless of treatment (no treatment: 100 %; steroid injection: 100 %; steroid injection followed by oral steroid: 71 %). Conclusions: Although prophylactic steroid administration is effective to prevent strictures for 7/8 circumference or larger mucosal defects, it is ineffective for whole-circumference defects. Further investigation is required.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-118291 |
| spellingShingle | Tomohiro Kadota Tomonori Yano Tomoji Kato Maomi Imajoh Masaaki Noguchi Hiroyuki Morimoto Shozo Osera Yusuke Yoda Yasuhiro Oono Hiroaki Ikematsu Atsushi Ohtsu Kazuhiro Kaneko Prophylactic steroid administration for strictures after endoscopic resection of large superficial esophageal squamous cell carcinoma Endoscopy International Open |
| title | Prophylactic
steroid administration for strictures after endoscopic resection of large
superficial esophageal squamous cell carcinoma |
| title_full | Prophylactic
steroid administration for strictures after endoscopic resection of large
superficial esophageal squamous cell carcinoma |
| title_fullStr | Prophylactic
steroid administration for strictures after endoscopic resection of large
superficial esophageal squamous cell carcinoma |
| title_full_unstemmed | Prophylactic
steroid administration for strictures after endoscopic resection of large
superficial esophageal squamous cell carcinoma |
| title_short | Prophylactic
steroid administration for strictures after endoscopic resection of large
superficial esophageal squamous cell carcinoma |
| title_sort | prophylactic steroid administration for strictures after endoscopic resection of large superficial esophageal squamous cell carcinoma |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-118291 |
| work_keys_str_mv | AT tomohirokadota prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT tomonoriyano prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT tomojikato prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT maomiimajoh prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT masaakinoguchi prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT hiroyukimorimoto prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT shozoosera prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT yusukeyoda prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT yasuhirooono prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT hiroakiikematsu prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT atsushiohtsu prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma AT kazuhirokaneko prophylacticsteroidadministrationforstricturesafterendoscopicresectionoflargesuperficialesophagealsquamouscellcarcinoma |