Skip to main content
SpringerLink
Log in

Prevention of esophageal stricture after endoscopic submucosal dissection of squamous cell carcinoma using a 20-French nasogastric tube combined with oral steroid administration

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Esophageal stricture is a major complication after esophageal endoscopic submucosal dissection (ESD) and when the mucosal defect exceeds 3/4 of the circumference. Various preventive methods have been reported to prevent stenosis. However, in the case of circumferential ESD, there is no way to prevent luminal stenosis effectively. This retrospective study aimed to evaluate the efficacy of 20-French nasogastric tubes (NGT) combined with oral steroids for the prevention of esophageal stricture after endoscopic submucosal dissection.

Methods

Between January 2012 and December 2021, we enrolled 57 patients with post-ESD mucosal defects exceeding 3/4 of the esophageal circumference. Of them, the initial seven patients received oral steroid therapy and the subsequent 50 patients received 20-French NGT placements combined with oral steroid therapy. We retrospectively evaluated the rates of strictures and refractory strictures and explored risk factors for strictures with 20-French NGT.

Results

The overall esophageal stricture rate was 42.1% (24/57). In the noncircumferential group, the esophageal stricture rate in patients with only oral steroid to prevent esophageal stricture was 85.7% (6/7), while the esophageal stricture rate was only 4.3% (1/23) in those with 20-French NGT placements and oral steroid. All 27 patients with whole-circumferential resection received 20-French NGT placements. The stricture rate was 63.0% (17/27), and the refractory stricture rate was 17.6% (3/27).

Conclusion

Using a 20-French NGT placement combined with oral steroid administration is an easy and safe alternative to prevent esophageal stricture after ESD, especially for patients with noncircumferential mucosal defects. Further studies are needed to develop an effective stricture prevention method for post-ESD whole-circumferential mucosal defects of the esophagus.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ishihara R, Arima M, Iizuka T, Oyama T, Katada C, Kato M, Goda K, Goto O, Tanaka K, Yano T, Yoshinaga S, Muto M, Kawakubo H, Fujishiro M, Yoshida M, Fujimoto K, Tajiri H, Inoue H, Japan Gastroenterological Endoscopy Society Guidelines Committee of ESDEMRfEC (2020) Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer. Dig Endosc 32:452–493

    Article  PubMed  Google Scholar 

  2. Mizutani T, Tanaka M, Eba J, Mizusawa J, Fukuda H, Hanaoka N, Takeuchi M, Aoyama I, Kojima T, Takizawa K, Ono H, Muto M, Gastrointestinal Endoscopy Study Group of the Japan Clinical Oncology G (2015) A phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, steroid EESD P3). Jpn J Clin Oncol 45:1087–1090

    Article  PubMed  Google Scholar 

  3. Kadota T, Yoda Y, Hori K, Shinmura K, Oono Y, Ikematsu H, Yano T (2020) Prophylactic steroid administration against strictures is not enough for mucosal defects involving the entire circumference of the esophageal lumen after esophageal endoscopic submucosal dissection (ESD). Esophagus 17:440–447

    Article  PubMed  Google Scholar 

  4. Iizuka T, Kikuchi D, Yamada A, Hoteya S, Kajiyama Y, Kaise M (2015) Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma. Endoscopy 47:341–344

    PubMed  Google Scholar 

  5. Iizuka T, Kikuchi D, Hoteya S, Kajiyama Y, Kaise M (2017) Polyglycolic acid sheet and fibrin glue for preventing esophageal stricture after endoscopic submucosal dissection: a historical control study. Dis Esophagus 30:1–8

    Article  CAS  PubMed  Google Scholar 

  6. Ohki T, Yamato M, Murakami D, Takagi R, Yang J, Namiki H, Okano T, Takasaki K (2006) Treatment of oesophageal ulcerations using endoscopic transplantation of tissue-engineered autologous oral mucosal epithelial cell sheets in a canine model. Gut 55:1704–1710

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Chai NL, Feng J, Li LS, Liu SZ, Du C, Zhang Q, Linghu EQ (2018) Effect of polyglycolic acid sheet plus esophageal stent placement in preventing esophageal stricture after endoscopic submucosal dissection in patients with early-stage esophageal cancer: a randomized, controlled trial. World J Gastroenterol 24:1046–1055

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wang J, Li SL, Wu N, Wu Q (2020) Effectiveness of fibrin sealant as a hemostatic technique in accelerating endoscopic submucosal dissection-induced ulcer healing and preventing stricture in the esophagus: a retrospective study. Oncol Lett 20:2322–2330

    Article  CAS  PubMed Central  Google Scholar 

  9. Wang J, Li SJ, Yan Y, Yuan P, Li WF, Cao CQ, Chen WG, Chen KN, Wu Q (2022) Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer. World J Gastroenterol 28:5957–5967

    Article  CAS  PubMed Central  Google Scholar 

  10. Zou J, Chai N, Linghu E, Wang Z, Li L (2022) Prevention of esophageal stricture after whole circumferential endoscopic resection: a review for endoscopists. Turk J Gastroenterol 33:811–821

    Article  PubMed  PubMed Central  Google Scholar 

  11. Katada C, Muto M, Manabe T, Boku N, Ohtsu A, Yoshida S (2003) Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc 57:165–169

    Article  PubMed  Google Scholar 

  12. Shi Q, Ju H, Yao LQ, Zhou PH, Xu MD, Chen T, Zhou JM, Chen TY, Zhong YS (2014) Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma. Endoscopy 46:640–644

    Article  PubMed  Google Scholar 

  13. Miwata T, Oka S, Tanaka S, Kagemoto K, Sanomura Y, Urabe Y, Hiyama T, Chayama K (2016) Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Surg Endosc 30:4049–4056

    Article  Google Scholar 

  14. Tang J, Kong F, Li J, Liu F, Kong X, Li Z (2021) Independent risk factors for esophageal refractory stricture after extensive endoscopic submucosal dissection. Surg Endosc 35:3618–3627

    Article  Google Scholar 

  15. Kochman ML, McClave SA, Boyce HW (2005) The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc 62:474–475

    Article  PubMed  Google Scholar 

  16. Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, Omata M (2009) Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy 41:661–665

    Article  CAS  Google Scholar 

  17. Ezoe Y, Muto M, Horimatsu T, Morita S, Miyamoto S, Mochizuki S, Minashi K, Yano T, Ohtsu A, Chiba T (2011) Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol 45:222–227

    Article  PubMed  Google Scholar 

  18. Hikichi T, Nakamura J, Takasumi M, Hashimoto M, Kato T, Kobashi R, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Okubo Y, Kobayakawa M, Ohira H (2020) Prevention of stricture after endoscopic submucosal dissection for superficial esophageal cancer: a review of the literature. J Clin Med 10:20

    Article  PubMed Central  Google Scholar 

  19. Mori H, Rafiq K, Kobara H, Fujihara S, Nishiyama N, Oryuu M, Suzuki Y, Masaki T (2013) Steroid permeation into the artificial ulcer by combined steroid gel application and balloon dilatation: prevention of esophageal stricture. J Gastroenterol Hepatol 28:999–1003

    Article  PubMed  Google Scholar 

  20. Shibagaki K, Ishimura N, Oshima N, Mishiro T, Fukuba N, Tamagawa Y, Yamashita N, Mikami H, Izumi D, Taniguchi H, Sato S, Ishihara S, Kinoshita Y (2018) Esophageal triamcinolone acetonide-filling method: a novel procedure to prevent stenosis after extensive esophageal endoscopic submucosal dissection (with videos). Gastrointest Endosc 87:380–389

    Article  PubMed  Google Scholar 

  21. Abe S, Iyer PG, Oda I, Kanai N, Saito Y (2017) Approaches for stricture prevention after esophageal endoscopic resection. Gastrointest Endosc 86:779–791

    Article  Google Scholar 

  22. Wen J, Lu Z, Linghu E, Yang Y, Yang J, Wang S, Yan B, Song J, Zhou X, Wang X, Meng K, Dou Y, Liu Q (2016) Prevention of esophageal strictures after endoscopic submucosal dissection with the injection of botulinum toxin type A. Gastrointest Endosc 84:606–613

    Article  Google Scholar 

  23. Lua GW, Tang J, Liu F, Li ZS (2016) Prevention of esophageal strictures after endoscopic submucosal dissection: a promising therapy using carboxymethyl cellulose sheets. Dig Dis Sci 61:1763–1769

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Ohki T, Yamato M, Ota M, Takagi R, Kondo M, Kanai N, Okano T, Yamamoto M (2015) Application of regenerative medical technology using tissue-engineered cell sheets for endoscopic submucosal dissection of esophageal neoplasms. Dig Endosc 27:182–188

    Article  PubMed  Google Scholar 

  25. Yamashina T, Uedo N, Fujii M, Ishihara R, Mikamori M, Motoori M, Yano M, Iishi H (2013) Delayed perforation after intralesional triamcinolone injection for esophageal stricture following endoscopic submucosal dissection. Endoscopy 45(Suppl 2):E92

    PubMed  Google Scholar 

  26. Iwatsubo T, Takeuchi T, Lee S-W, Kawaguchi S, Ota K, Kojima Y, Higuchi K (2022) Very delayed perforation after esophageal endoscopic submucosal dissection and intralesional triamcinolone injection. Case Rep Gastroenterol 16:462–468

    Article  PubMed  PubMed Central  Google Scholar 

  27. Chu Y, Chen T, Li H, Zhou P, Zhang Y, Chen W, Zhong Y, Yao L, Xu M (2019) Long-term efficacy and safety of intralesional steroid injection plus oral steroid administration in preventing stricture after endoscopic submucosal dissection for esophageal epithelial neoplasms. Surg Endosc 33:1244–1251

    Article  Google Scholar 

  28. 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

    PubMed  Google Scholar 

  29. Yamaguchi N, Isomoto H, Fukuda H (2013) Preventing stenosis after circumferential and semi-circumferential esophageal ESD-effect of oral steroid administration. Stomach Intest 48:1291–1302

    Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. Kadota T, Yano T, Kato T, Imajoh M, Noguchi M, Morimoto H, Osera S, Yoda Y, Oono Y, Ikematsu H, Ohtsu A, Kaneko K (2016) Prophylactic steroid administration for strictures after endoscopic resection of large superficial esophageal squamous cell carcinoma. Endosc Int Open 4:E1267–E1274

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hashimoto S, Mizuno KI, Takahashi K, Sato H, Yokoyama J, Takeuchi M, Sato Y, Kobayashi M, Terai S (2019) Evaluating the effect of injecting triamcinolone acetonide in two sessions for preventing esophageal stricture after endoscopic submucosal dissection. Endosc Int Open 7:E764–E770

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wang Q, Wu Z, Shi J, Hou S, Shan F, Li S, Zhang Y, Li Z, Ji J (2022) Omitting nasogastric tube placement after gastrectomy does not enhance postoperative recovery: a propensity score matched analysis. Langenbecks Arch Surg 407:113–122

    Article  PubMed  Google Scholar 

  34. Bull A, Pucher PH, Maynard N, Underwood TJ, Lagergren J, Gossage JA, Association of Upper Gastrointestinal S (2022) Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes. Eur J Surg Oncol 48:1033–1038

    Article  PubMed  Google Scholar 

  35. Pillai JB, Vegas A, Brister S (2005) Thoracic complications of nasogastric tube: review of safe practice. Interact Cardiovasc Thorac Surg 4:429–433

    Article  Google Scholar 

  36. Leonard S, O’Connell S, O’Connor M (2012) Complications of nasogastric tube placement-don’t blow it. Ir Med J 105:116–117

    CAS  PubMed  Google Scholar 

  37. Andresen EN, Frydland M, Usinger L (2016) Deadly pressure pneumothorax after withdrawal of misplaced feeding tube: a case report. J Med Case Rep 10:30

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ishigami A, Kubo S, Tokunaga I, Gotohda T, Nishimura A (2009) An autopsy case of severe pleuritis induced by misinsertion of a nasogastric nourishment tube: diagnostic significance of multinucleated giant cells. Leg Med (Tokyo) 11:191–194

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Springer Nature for its linguistic assistance.

Funding

This study was supported by Wu Jie-Ping Medical Foundation Special Fund for Clinical Research (320.6750.2021-04-71); Open Research Fund of NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases (KF202101); Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (2020-PT330-003); Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (XMLX202143); Capital’s Funds for Health Improvement and Research (2020-2-2155); and Beijing Municipal Administration of Hospitals Incubating Program (PX2020047).

Author information

Author notes

  1. Jing Wang and Weifeng Li have contributed equally to this manuscript and are equal contributors.

Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China

    Jing Wang, Weifeng Li, Yan Yan, Peng Yuan, Changqi Cao, Shijie Li & Qi Wu

  2. First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832008, China

    Shijie Li

Authors
  1. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Weifeng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yan Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peng Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Changqi Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shijie Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qi Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Shijie Li or Qi Wu.

Ethics declarations

Disclosures

Jing Wang, Weifeng Li, Yan Yan, Peng Yuan, Changqi Cao, Shijie Li, and Qi Wu have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 156218 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, J., Li, W., Yan, Y. et al. Prevention of esophageal stricture after endoscopic submucosal dissection of squamous cell carcinoma using a 20-French nasogastric tube combined with oral steroid administration. Surg Endosc 37, 8892–8900 (2023). https://doi.org/10.1007/s00464-023-10469-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10469-0

Keywords

Search

Navigation