Abstract
Background
Stenosis is a troublesome complication after wide endoscopic submucosal dissection (ESD). As steroids are known to prevent post-ESD esophageal stenosis, this study aimed to clarify the gastric effects.
Methods
This was a retrospective single-institution study. Between September 2002 and June 2015, 132 patients with a post-ESD mucosal defect exceeding three-fourths of the circumference were identified. Among them, 107 patients who did not undergo additional surgery for non-curative resection were reviewed. Steroid treatment (local injection and/or systemic) for stenosis prevention was administered to 28 patients within 10 days after ESD (steroid group). The incidence of stenosis and course of therapeutic endoscopic balloon dilation (EBD) were analyzed between the steroid and non-steroid group.
Results
Stenosis occurred in 31% (33/107) of patients. Full circumferential defect and defect extending to the pyloric ring were significantly related with stenosis. The proportion of patients with a full circumferential defect was relatively higher in the steroid group (14%) compared to the non-steroid group (5%) (p = 0.111). There was no significant relationship between the incidence of stenosis and the use of steroids (steroid group 39%, non-steroid group 28%, p = 0.260). However, the interval from ESD to stenosis was significantly delayed among steroid-treated patients with a near-circumferential to three-fourth mucosal defect (p = 0.001) and among patients with ESD in the lower stomach (p = 0.002). The number of therapeutic EBDs and treatment duration did not differ significantly between the groups. Steroid treatment did not increase the incidence of ESD- and EBD-related complications.
Conclusion
Despite the retardation of the occurrence of stenosis in some subgroups, early steroid treatment did not a show a significant effect on stenosis prevention after wide gastric ESD. Further evaluation is needed to determine the dose and timing of steroid treatment for stenosis after wide gastric ESD.
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References
Ono H, Yao K, Fujishiro M, Oda I, Nimura S, Yahagi N, Iishi H, Oka M, Ajioka Y, Ichinose M, Matsui T (2016) Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc 28:3–15
Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123
Kakushima N, Yahagi N, Fujishiro M, Iguchi M, Oka M, Kobayashi K, Hashimoto T, Omata M (2004) The healing process of gastric artificial ulcers after endoscopic submucosal dissection. Dig Endosc 16:327–331
Kakushima N, Fujishiro M, Kodashima S, Kobayashi K, Tateishi A, Iguchi M, Imagawa A, Motoi T, Yahagi N, Omata M (2006) Histopathologic characteristics of gastric ulcers created by endoscopic submucosal dissection. Endoscopy 38:412–415
Kakushima N, Fujishiro M, Yahagi N, Kodashima S, Nakamura M, Omata M (2006) Helicobacter pylori status and the extent of gastric atrophy do not affect ulcer healing after endoscopic submucosal dissection. J Gastroenterol Hepatol 21:1586–1589
Iizuka H, Kakizaki S, Sohara N, Onozato Y, Ishihara H, Okamura S, Itoh H, Mori M (2010) Stricture after endoscopic submucosal dissection for early gastric cancers and adenomas. Dig Endosc 22:282–288
Kakushima N, Tanaka M, Sawai H, Imai K, Kawata N, Hagiwara T, Takao T, Hotta K, Yamaguchi Y, Takizawa K, Matsubayashi H, Ono H (2013) Gastric obstruction after endoscopic submucosal dissection. United Eur Gastroenterol J 1:184–190
Coda S, Oda I, Gotoda T, Yokoi C, Kikuchi T, Ono H (2009) Risk factors for cardiac and pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment. Endoscopy 41:421–426
Kishida Y, Kakushima N, Kawata N, Tanaka M, Takizawa K, Imai K, Hotta K, Matsubayashi H, Ono H (2015) Adverse events associated with endoscopic dilation for gastric stenosis after endoscopic submucosal dissection for early gastric cancer. Surg Endosc 29:3776–3782
Hashimoto S, Kobayashi M, Takeuchi M, Sato Y, Narisawa R, Aoyagi Y (2011) The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 74:1389–1393
Yamaguchi N, Isomoto H, Nakayama T, Hayashi T, Nishiyama H, Ohnita K, Takeshima F, Shikuwa S, Kohno S, Nakao K (2011) Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 73:1115–1121
Hanaoka N, Ishihara R, Takeuchi Y, Uedo N, Higashino K, Ohta T, Kanzaki H, Hanafusa M, Nagai K, Matsui F, Iishi H, Tatsuta M, Ito Y (2012) Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy 44:1007–1011
Fujimoto K, Fujishiro M, Kato M, Higuchi K, Iwakiri R, Sakamoto C, Uchiyama S, Kashiwagi A, Ogawa H, Murakami K, Mine T, Yoshino J, Kinoshita Y, Ichinose M, Matsui T (2014) Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 26:1–14
Kishida Y, Kakushima N, Kawata N, Tanaka M, Takizawa K, Imai K, Hotta K, Matsubayashi H, Ono H (2015) Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer. Surg Endosc 29:2953–2959
Kataoka M, Anzai S, Shirasaki T, Ikemiyagi H, Fujii T, Mabuchi K, Suzuki S, Yoshida M, Kawai T, Kitajima M (2015) Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer. Endosc Int Open 3:E113–E117
Shoji H, Yamaguchi N, Isomoto H, Minami H, Matsushima K, Akazawa Y, Ohnita K, Takeshima F, Shikuwa S, Nakao K (2014) Oral prednisolone and triamcinolone injection for gastric stricture after endoscopic submucosal dissection. Ann Transl Med 2:22
Mori H, Rafiq K, Kobara H, Fujihara S, Nishiyama N, Kobayashi M, Himoto T, Haba R, Hagiike M, Izuishi K, Okano K, Suzuki Y, Masaki T (2012) Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity. Endoscopy 44:641–648
Mori H, Kobara H, Fujihara S, Nishiyama N, Rafiq K, Masaki T (2012) Recanalization of severe gastric antral stricture after large endoscopic submucosal dissection: mucosal incision and local steroid injection. J Gastrointestin Liver Dis 21:435–437
Mori H, Kobara H, Rafiq K, Nishiyama N, Fujihara S, Matsunaga T, Ayaki M, Yachida T, Masaki T (2015) Novel method for the management of stenosis after gastric endoscopic submucosal dissection: mucosal incision with steroid injection contralateral to the severely contracted scar. Dig Endosc 27:622–626
Okada K, Yamamoto Y, Kasuga A, Omae M, Kubota M, Hirasawa T, Ishiyama A, Chino A, Tsuchida T, Fujisaki J, Nakajima A, Hoshino E, Igarashi M (2011) Risk factors for delayed bleeding after endoscopic submucosal dissection for gastric neoplasm. Surg Endosc 25:98–107
Toyokawa T, Inaba T, Omote S, Okamoto A, Miyasaka R, Watanabe K, Izumikawa K, Horii J, Fujita I, Ishikawa S, Morikawa T, Murakami T, Tomoda J (2012) Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: analysis of 1123 lesions. J Gastroenterol Hepatol 27:907–912
Miyahara K, Iwakiri R, Shimoda R, Sakata Y, Fujise T, Shiraishi R, Yamaguchi K, Watanabe A, Yamaguchi D, Higuchi T, Tominaga N, Ogata S, Tsuruoka N, Noda T, Hidaka H, Mannen K, Endo H, Yamanouchi K, Yamazato T, Sakata H, Fujimoto K (2012) Perforation and postoperative bleeding of endoscopic submucosal dissection in gastric tumors: analysis of 1190 lesions in low- and high-volume centers in Saga, Japan. Digestion 86:273–280
Suzuki H, Oda I, Sekiguchi M, Abe S, Nonaka S, Yoshinaga S, Nakajima T, Saito Y (2015) Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection. World J Gastroenterol 21:12635–12643
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Drs. Yoshihiro Kishida, Naomi Kakushima, Kohei Takizawa, Masaki Tanaka, Noboru Kawata, Masao Yoshida, Sayo Ito, Kenichiro Imai, Hirotoshi Ishiwatari, Kinichi Hotta, Hiroyuki Matsubayashi, and Hiroyuki Ono have no conflict of interest or interests of financial ties to disclose.
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Kishida, Y., Kakushima, N., Takizawa, K. et al. Effects of steroid use for stenosis prevention after wide endoscopic submucosal dissection for gastric neoplasm. Surg Endosc 32, 751–759 (2018). https://doi.org/10.1007/s00464-017-5732-5
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DOI: https://doi.org/10.1007/s00464-017-5732-5