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Utility of radial incision and cutting with steroid injection for refractory stricture after endoscopic submucosal dissection for large superficial esophageal squamous cell carcinoma

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Abstract

Background and aims

Endoscopic submucosal dissection (ESD) for superficial esophagus squamous cell carcinoma (SESCC) may cause esophageal stricture and related dysphagia symptoms, especially when the lesion is widespread. Endoscopic balloon dilation (EBD) is the prior choice to treat post-ESD stricture. However, certain patients show poor response to EBD treatment and frequent dilations are required. We perform radial incision and cutting combined with intralesional steroid injection to manage refractory stricture. The study aims to evaluate the safety and efficacy of this new combined treatment.

Methods

From October 2017 to February 2019, 25 patients who accepted repeated EBD because of refractory stricture after extensive ESD for large SESCC were enrolled. Radial incision and cutting followed by local steroid injection was performed on all the patients, and therapeutic EBD was conducted to treat recurring stricture after combined treatment. The incidence of recurrent stricture, clinical outcome of combined treatment, and following therapeutic EBD, procedure-related adverse events were assessed and analyzed.

Results

During the follow-ups, the incidence of recurrent esophageal strictures was 92%. Combined treatment reduced the severity of stenosis and lowered the corresponding dysphagia scores significantly, compared with previous EBD. Mean symptom-relief duration of EBD was prolonged significantly from 29.9 to 76.0 days. Perforation was observed in one patient during operation and successfully sealed with metal clips.

Conclusions

Combination of radial incision and cutting with steroid injection is a safe and feasible treatment for esophageal refractory stricture after extensive ESD, appearing to improve the therapeutic EBD outcome and maintain a longer symptom-relief duration.

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    Authors and Affiliations

    1. Department of Gastroenterology, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China

      Jingyuan Xiang, Enqiang Linghu, Longsong Li, Jiale Zou, Xiangyao Wang & Ningli Chai

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    1. Jingyuan Xiang
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    2. Enqiang Linghu
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    3. Longsong Li
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    6. Ningli Chai
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    Contributions

    Our research was mainly designed by NC and EL. All operations were operated by NC. JX, LL, JZ, and XW devoted themselves to collecting data and follow-ups. JX drafted the article. Analysis and interpretation: NC and EL. Critical revision of the article for important intellectual content: NC and EL. Final approval of the article: NC.

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    Correspondence to Ningli Chai.

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    Drs. Jingyuan Xiang, Enqiang Linghu, Longsong Li, Jiale Zou, Xiangyao Wang, and Ningli Chai have no conflicts of interest or financial ties to disclose.

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    Jingyuan Xiang and Enqiang Linghu sharing co-first authors.

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    Xiang, J., Linghu, E., Li, L. et al. Utility of radial incision and cutting with steroid injection for refractory stricture after endoscopic submucosal dissection for large superficial esophageal squamous cell carcinoma. Surg Endosc 35, 6930–6937 (2021). https://doi.org/10.1007/s00464-020-08204-0

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