| Background and purpose:The mechanism of esophageal stricture after ESD is not clear.It is related to local inflammatory reaction,fibrosis,cell proliferation and other factors.At present,there is no effective preventive measures.Traditional Chinese medicine has obvious anti-inflammatory and anti fibrosis effects.In this study,part of 69 cases of patients with large-scale superficial esophageal early cancer after ESD(The diameter of mucosa defect of instant tube≥1/2 circumference)were treated with traditional Chinese medicine,and the clinical data were analyzed.Method:1.Through prospective study,from January 2018 to March 2020,in the Department of Gastroenterology,the fisrt Affiliated Hospital of Suzhou University and the endoscopy center of Wuxi People’s Hospital,some of the patients who met the TCM syndrome diagnosis standard of liver depression and spleen deficiency syndrome after ESD operation of esophageal early cancer with the diameter of mucosal defect≥1/2 of the circumference,The patients were divided into two teams according to the circumference ratio of mucosal defect after ESD(team no.1:≥1/2 circumference and<3/4 circumference;team no.2:≥3/4 circumference).Team no.1 and team no.2 were further divided into A control group,B oral hormone group and C oral hormone+oral JWXG Decoction group.Postoperative follow-up time≥3 months;2.The incidence of dysphagia,esophageal stricture and endoscopic dilation were analyzed.To compare the clinical data of the oral hormone+JWXG Decoction group with that of the control group(no prevention of stricture after ESD)and the simple oral hormone group,and to evaluate the preventive effect of the oral JWXG Decoction on esophageal stricture.Result:1.In the end,69 patients were enrolled and followed up,including 35 in team no.l and 34 in team no.2.There was no significant difference in age,gender,location of lesion,longitudinal diameter of lesion resection,preoperative pathological type and depth of lesion invasion between teams no.l and no.2(P>0.05).2.During the follow-up,each patient was evaluated by EORTC qlq-oes18.There was no significant difference between the control group and the simple ora hormone group,in team no.l and team no.2(P>0.05).But in same team,the score of oral hormone+JWXG Decoction group was significant lower than that of the control group and the simple oral hormone group(P<0.05),the difference was statistically significant.3.Stenosis rate analysis:A total of 32 patients with esophageal stenosis were finally diagnosed.The stenosis rates of team no.1(≥1/2 weeks and<3/4 weeks)and team no.2(≥3/4 weeks)were 13/35(37.1%)and 19/34(55.9%)respectively,which indicated that the circumference of mucosal defect became larger and the stenosis rate increased.For team no.1,63.6%(7/11).33.3%(4/12)and 16.7%(2/12)of esophageal stenosis were found in the oral hormone group,the experimental control group and the oral hormone+JWXG Decoction group.For team no.2,the experimental control group,the oral hormone group and the oral hormone+JWXG Decoction group showed different stenosis rate values:100%(11/11).45.5%(5/11).25%(3/12)。In team no.1 and team no.2,the stenosis rate of oral hormone+JWXG Decoction group was significantly lower than that of the control group and oral hormone group(P<0.05),the difference was statistically significant.4.Analysis of the times of esophageal dilatation after operation:compared with the average times of dilatation in each group,the control group(3.58 times),the simple oral hormone group(2.560 times),the oral hormone+JWXG Decoction group(1.80 times),the oral hormone+JWXG Decoction group was significantly lower than the control group and the oral hormone group,P<0.05,the difference was statistically significant.5.In this study,the longitudinal diameter of lesions in stenosis group and non stenosis group were analyzed retrospectively.There was a significant difference in the stenosis rate between the groups with longitudinal diameter<5.5 cm and≥5.5 cm(P=0.025).。Conclusion:1.The incidence of esophageal stenosis after large-scale ESD operation can be reduced by oral administration of Traditional Chinese medicine JWXG Decoction.2.Number of dilations after esophageal stenosis because of large-scale esophageal ESD operation were significantly reduced by oral administration of Traditional Chinese medicine JWXG Decoction..3.The oral administration of JWXG Decoction can significantly improve the early satiety,reflux,dysphagia and other clinical symptoms of esophageal stenosis after ESD.4.ESD is a safe and effective endoscopic minimally invasive treatment for early esophageal cancer,and the longitudinal diameter of lesions is also a factor affecting postoperative esophageal stenosis. |
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