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Locoregional steroid injection prevents stricture formation after endoscopic submucosal dissection for esophageal cancer: a propensity score matching analysis

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Abstract

Background

Although endoscopic submucosal dissection (ESD) has become accepted for the treatment of superficial esophageal cancer, the incidence of stricture formation caused by ESD for widespread lesions is high and leads to a low quality of life. A few studies reported that locoregional steroid injections are useful for the prevention of such stricture formation compared with historical controls. We evaluated the efficacy of prophylactic locoregional steroid injections for stricture formation caused by ESD using quasi-randomized analysis.

Methods

This matched case–control study included 461 superficial esophageal cancers from 305 patients who underwent ESD between 2006 and 2013. We used two methods of locoregional steroid injection to prevent stricture formation after ESD. A propensity score matching analysis was performed to reduce the effects of a selection bias for steroid injections and other potential confounding factors. In addition, generalized estimating equations were used to analyze repeated measures data. We compared the incidence of stricture formation with or without steroid injections.

Results

Forty-two lesions were treated with locoregional steroid injection (dexamethasone/triamcinolone, 23/19) after ESD and esophageal stricture formation occurred in 36 lesions. Fifty-six lesions treated with or without steroid injections were matched after propensity score matching. Locoregional steroid injection reduced the incidence of stricture formation to 10.7 % (3/28) of patients compared with 35.7 % (10/28) in the control group (odds ratio 4.63, 95 % confidence interval 1.11–19.25, p = 0.035).

Conclusions

Locoregional steroid injections could be efficient for the prevention of stricture formation after ESD for superficial esophageal cancer.

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Authors and Affiliations

  1. Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Yasuaki Nagami, Masatsugu Shiba, Kazunari Tominaga, Hiroaki Minamino, Masaki Ominami, Shusei Fukunaga, Satoshi Sugimori, Tetsuya Tanigawa, Hirokazu Yamagami, Kenji Watanabe, Toshio Watanabe, Yasuhiro Fujiwara & Tetsuo Arakawa

Authors
  1. Yasuaki Nagami
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  2. Masatsugu Shiba
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  3. Kazunari Tominaga
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  4. Hiroaki Minamino
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Corresponding author

Correspondence to Yasuaki Nagami.

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Disclosures

Tetsuo Arakawa had advisory committees by Otsuka Pharmaceutical Co. Ltd. and Eisai Co. Ltd. Toshio Watanabe had advisory committees by Eisai Co. Ltd. Kenji Watanabe had advisory committees by Abbott Japan Co. Ltd., Mitsubishi Tanabe Pharma Corporation, Eisai Co. Ltd., JIMRO Co. Ltd., Asahi Kasei Medical Co. Ltd., Ajinomoto Pharmaceuticals Co. Ltd., Kyowa Hakko Kirin Co. Ltd., Kyorin Pharmaceutical Co. Ltd., Astellas Pharma Inc, UCB Japan Co. Ltd., Takeda Pharmaceutical Co. Ltd., Dainippon Sumitomo Pharma Co. Ltd., Horii Pharmaceutical Ind. Ltd. Drs. Nagami, Shiba, Tominaga, Minamino, Ominami, Fukunaga, Sugimori, Tanigawa, Yamagami, Fujiwara declare that they have no conflict of interest.

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Nagami, Y., Shiba, M., Tominaga, K. et al. Locoregional steroid injection prevents stricture formation after endoscopic submucosal dissection for esophageal cancer: a propensity score matching analysis. Surg Endosc 30, 1441–1449 (2016). https://doi.org/10.1007/s00464-015-4348-x

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  • DOI: https://doi.org/10.1007/s00464-015-4348-x

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