Observation On The Effect Of Glucocorticoids In Preventing Esophageal Stenosis After Endoscopic Submucosal Dissection Of Superficial Esophageal Squamous Cell Carcinoma

BackgroundEarly esophageal squamous cell carcinoma is limited to the esophageal mucosa,while squamous cell carcinoma invading the submucosa is superficial esophageal carcinoma.Endoscopic submucosla dissection(ESD)has developed as a viable treatment for superficial esophageal cancer.ESD has significant advantages because it allows for complete excision and accurate histopathological assessment,with a complete excision rate of 78-100%and a low recurrence rate of 0-2.6%.ESD is effective for the treatment of esophageal cancer that invades M1(intrapethelial)or M2(invasion into the lamina propria)because there is almost no lymphatic invasion.However,tumors containing lymphatic vascular invasion or submucosal invasion greater than 200?m should be treated as advanced cancer.The most common adverse events in esophageal ESD include perforation and stenosis.Perforation can usually be closed by titanium clip or conservative treatment,and hormone administration can effectively prevent esophageal stricture.Based on the current research,there is no uniformity in the dose,course of treatment and administration time of hormone-induced esophageal stricture after ESD,and there are few domestic reports.ObjectiveTo evaluate the efficacy and safety of oral glucocorticoid in the prevention of esophageal stenosis after endoscopic submucosal dissection for superficial squamous cell carcinoma and precancerous lesions.Methods97 patients with superficial esophageal cancer diagnosed from the first affiliated hospital of Zhengzhou University from October 2016 to July 2018 were selected.Histopathological examination was performed before ESD,and the results were returned to esophageal squamous cell carcinoma or high-grade intraepithelial neoplasia.Endoscopic ultrasonography showed that the tumor invaded the mucosa or the depth of invasion did not exceed 1/3 of the submucosal layer,and all were treated with ESD.Patients were randomly assigned to a modified hormone group(group A),a primary hormone group(group B),and a control group(group C).The age,sex,preoperative pathological type,tumor location,depth of lesion infiltration,pathological extent of the esophagus and long diameter of the lesion,and the stage of ulceration in each group at 4 weeks after ESD and 4 weeks after ESD were counted.The S1 stage ulcer healing rate,the incidence of stenosis in each group at 4 weeks after ESD,Endoscopic balloon dilatation(EBD)in 6 months after ESD and the adverse reactions associated with oral administration of hormones were statistically analyzed.Results1.The study was finally included in 97 patients,including 53 males and 44females;19 males in group A and 15 females,mean age(56.4±6.1)years old;18males in group B,14 females,average age(56.8±5.3)years old;16 males and 15females in group C,with an average age of(60.0±5.3)years.There were no significant differences in age,gender,preoperative pathological type,tumor location,lesion infiltration depth,lesion circumference and esophageal circumference(P>0.05),which were comparable.2.The gastroscopy was reviewed 4 weeks after ESD.The number of ulcer healing stages(S1/H2/H1/A2)in group A,B and C were(25/5/2/2),(24/5/2/1),(27/2/1/1),there was no significant difference in each group(P>0.05).The number of ulcer scar and non-scarring period(S1/H2+H1+A2)in the A,B and C groups were(25/9),(24/8)and(27/4),respectively.The healing rate of S1 was 73.5%,75.0%and87.1%,the differences between the groups were not statistically significant(P>0.05).The number of stenosis and non-stenosis in group A,B and C were(8/26),(6/26)and(23/8),respectively.The stenosis rates were 23.5%,18.8%and 74.2%,respectively.The difference was statistically significant(?~2=25.25,P<0.01).The incidence of stenosis in group A and group C,group B and group C was statistically significant(P<0.01).After ESD was followed up for 6 months,the number of EBD treatments in group A,B and C was 2.0(0-4.0),2.0(0-3.0)and 6.0(0-13.0),respectively.The significance of learning(H=48.51,P<0.01);between the two groups,there was no significant difference in the number of EBD received between group A and group B in 6 months(Z=1.99,P=0.137).There was a statistically significant difference in the number of EBD received between group A and group C in 6 months.(Z=4.89,P<0.01).The difference in the number of EBD received between group B and group C in ESD was statistically significant(Z=6.78,P<0.01).3.Adverse events that may be associated with pneumonia,oral herpes infection,arthritis,and candida esophagitis with oral hormonal administration were observed in group B.Pneumonia was also observed in group A.The difference was statistically significant(P<0.05).The adverse events associated with oral hormonal administration were higher in group B than in group A,but all cases were controlled by conservative treatment.No adverse events associated with oral hormonal administration occurred in group C.Conclusions1.Oral steroids after ESD can reduce the rate of esophageal stenosis,reduce the number of postoperative EBD,and have no effect on postoperative wound healing.2.Low-dose,short-course oral steroids have relatively few adverse reactions and have comparable efficacy.3.Oral steroids are safe after esophageal ESD.