Efficacy Of Glucocorticoids For Prevention Of Esophageal Stenosis After Endoscopic Submucosal Dissection

Research Background:At present,endoscopic techniques are recommended for early esophageal neoplasm or precancerous lesions,such as endoscopic submucosal dissection（ESD）,which possesses the advantages of minor injury,shorter duration of hospital stay and less postoperative complications.However,the common complication after ESD is esophageal stricture,which affects the swallowing function and reduces the quality of life of patients.For patients with mucosal defect larger than 3/4 circumference of esophagus,the stenosis rate after ESD,is as high as 83.3%^[1].Endoscopic bougie dilatation（EBD）is currently recognized as an effective method for the treatment of esophageal stricture after ESD,but its recurrence rate is high,and repeated dilatation treatment will cause perforation,bleeding and other complications^[2].Therefore,exploring more effective and safer methods of prevent esophageal stricture after ESD is very necessary for the development of endoscopic therapy at present.In recent years,corticosteroids have been gradually used to prevent esophageal stricture after ESD.There are two main ways of administration:oral prednisolone acetate and local injection of triamcinolone acetonide.At present,many studies at home and abroad show that the results are rather different^[3-9].Based on these existing studies and our own experience,QIU Yu conducted a study to retrospectively compare the effectiveness and safety of oral and oral combined with local injection of corticosteroids in preventing esophageal stenosis after ESD.Purpose:To evaluate and compare the efficacy and safety of oral prednisone acetate and oral prednisone acetate combined with local injection of triamcinolone acetonide in the prevention of esophageal stricture after endoscopic submucosal dissection（ESD）for early esophageal neoplasm and precancerous lesions.Methods:The data of 52 patients with early esophageal cancer or precancerous lesions from December 2014 to February 2019 in Zhongda Hospital Affiliated to Southeast University were analyzed retrospectively.They were divided into control group（group A,n=20）,oral steroid group（group B,n=17）and oral combined with local injection group（group C,n=15）.The background information,stenosis rate,endoscopic dilatation times,time interval of first dilation after ESD and adverse events of the three groups were compared.Results:There was no significant difference in age,sex,lesion location,lesion circumference,lesion length,lesion depth and post-operative pathology among the three groups（P>0.05）.The difference of stenosis rate among the three groups was statistically significant[85.0%（17/20）VS 47.1%（8/17）VS 46.7%(7/15,X²=7.559,P<0.01].In pairwise comparison,the stenosis rate in group B and group C was significantly lower than that in group A,and there was no statistical difference in stenosis rate between group B and group C（P>0.05）.During follow-up period after ESD,the difference of endoscopic dilatation times among the three groups was statistically significant（4.2±2.9 VS 1.4±2.2 VS 1.1±1.3,P<0.01）.In pairwise comparison,the times of endoscopic dilatation in group B and group C was significantly less than that in group A（P<0.01）,but there was no significant difference between group B and group C（P=0.74）.There was significant difference in the time interval of the first endoscopic dilation after ESD among the three groups（27.7±9.4d VS 110.1±46.0d VS 147.4±9.4d,P<0.001）.In pairwise comparison,the first dilation interval in group B and group C was longer than that in group A（P<0.001）,and the first dilation interval in group C was longer than that in group B（P<0.001）.Two patients in control group developed perforation after ESD but they were treated actively and recovered finally.No ESD or steroid-related severe adverse events occurred in other patients of the three groups.Conclusion:Both of oral prednisone and oral prednisone combined with local injection of triamcinolone acetonide after ESD can effectively and safely prevent esophageal stricture after ESD,which is worth further promoting and exploring the most proper time and dose of oral administration.Although oral administration combined with local injection of corticosteroids has no obvious advantage in reducing stenosis rate and the times of dilatation,it can prolong the time interval of the first dilation after ESD,which is beneficial to the psychological recovery and the improvement of quality of life of patients after operation.