Local Steroid Injection After Esophageal ESD Does Not Prevent Strictures in All Patients
Prateek Sharma, MD, FASGE, reviewing Miyake M, et al. Gastrointest Endosc 2023 Mar 27.
Local triamcinolone (TA) therapy involves injecting approximately a 100-mg dose of TA into the ulcer immediately after an endoscopic submucosal dissection procedure to reduce the stricture rate, but up to 45% of patients still develop strictures after the injection. Predicting the risk of stricture formation after local TA injection is essential for administering additional interventions, such as repeat injections or oral steroids, in high-risk patients.
This prospective single-center study was performed at the Osaka International Cancer Institute in Japan from September 2017 to July 2022. A total of 203 patients were analyzed, and multivariate analysis identified a residual mucosal width of ≤5 mm (odds ratio [OR], 29.0; P<.0001) or 6 to 10 mm (OR, 3.7; P=.04), a history of chemoradiotherapy (OR, 5.1; P=.045), and tumor in the cervical or upper thoracic esophagus (OR, 3.8; P=.018) as independent predictors of stricture.
Patients were stratified into two groups based on stricture risk. The high-risk group (residual mucosal width ≤5 mm or 6 to 10 mm plus another predictor) had a stricture rate of 52.5% (31/59 cases), whereas the low-risk group (residual mucosal width ≥10 mm or 6 to 10 mm without other predictors) had a stricture rate of 6.3% (9/144 cases).
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Miyake M, Ishihara R, Matsuura N, et al. Predictors of stricture after non-circumferential endoscopic submucosal dissection of the esophagus and single-dose triamcinolone injection immediately after the procedure. Gastrointest Endosc 2023 Mar 27 (Epub ahead of print) (https://doi.org/10.1016/j.gie.2023.03.017)