The Preventive Effect Of Glucocorticoid On Esophageal Strictures After Endoscopic Submucosal Dissection For Large Area Of Early Esophageal Cancer

Objective: To explore the preventive effect of glucocorticoids on esophageal strictures after endoscopic submucosal dissection(ESD)in largearea early esophageal cancer.Methods:1.From May 2017 to November 2018,patients with early esophageal cancer who had 3/4 or larger circumferential mucosal defects after ESD in the department of gastroenterology of our hospital were collected.The patients were divided into two groups according to the width of mucosal defect after ESD(group A: 3/4 and <1;Group B: circumferential).Group A and group B were further subdivided into a: control group,b: oral steroid group and c: local injection steroid + oral steroid group.2.The incidence of esophageal stricture and the number of endoscopic balloon dilation(EBD)treatment were statistically analyzed.Esophageal stenosis was defined as: postoperative difficulty in swallowing food,and the standard endoscope with a diameter of 9.8mm could not pass through the stenosis.3.Patients were followed up for general postoperative conditions and side effects of prophylactic steroid therapy.Results:1.A total of 25 patients were recruited,including 15 in group A and 10 in group B.2.The stricture rates of group A and group B were 46.7%(7/15)and 100%(10/10),respectively,P=0.008,and the difference was statistically significant.In group A,the rates of esophageal stricture were 100%(5/5),25%(1/4),and 16.7%(1/6)in the control group,oral steroid group,and local injection steroid + oral steroid group,respectively,P=0.013,and the difference was statistically significant.The rate of esophageal stricture in the oral steroid group was lower than that in the control group(P=0.048),and the difference was statistically significant.The rate of esophageal stricture in the local injection steroid + oral steroid group was lower than that in the control group,P=0.015,and the difference was statistically significant.There was no statistically significant difference in the rate of esophageal stricture between the local injection steroid group and the oral steroid group(P=1).However,in group B,the stricture rate was high regardless of the prophylaxis administered(control: 100%(1/1);Oral steroid group: 100%(4/4);Local injection steroid + oral steroid group(5/5): 100%.The stricture rate was compared according to the length of the mucosal defect(< 64 mm,64mm),and the difference was not statistically significant.3.In this retrospective study,the frequency of EBD treatment was assessed in 25 patients.The median and range of EBD treatment in the control group,oral steroid group and local injection steroid + oral steroid group were 1.5 times(0-3 times),0 time(0-6 times)and 0 time(0-6 times),respectively.In group B,despite repeated EBD treatment for esophageal stricture,two patients were still unable to relieve dysphagia.Subsequently,metal covered stent implantation and stricture radial incision were performed to treat esophageal stricture.No esophageal perforation or massive bleeding were found in all patients receiving EBD treatment,and no poststernal pain or other complications were found after treatment.4.In this study,no ESD-related complications,such as bleeding,perforation or severe infection,were found.No adverse effects were found,such as perforation,bleeding,diabetes,peptic ulcer,adrenocortical insufficiency,psychosis,or infection.Conclusion:1.Both oral hormone therapy and local injection of hormone + oral hormone therapy can effectively prevent ESD postoperative stenosis with greater than or equal to 3/4 or even periferential mucosal defects,and have equal efficacy and good safety.2.Oral hormone therapy and local injection of hormone + oral hormone therapy have no effect on the prevention of postoperative stenosis of circumferential mucosal defect.3.Oral hormone and local injection combined with oral hormone therapy can reduce the number of EBD treatments needed for postoperative stenosis of ESD in early esophageal cancer.