Prevention Of Glucocorticoid On Esophageal Stricture After Endoscopic Submucosal Dissection

Objective:To investigate the role of glucocorticoid spraying after endoscopic submucosal dissection(ESD)in the prevention of postoperative stricture in patients with early esophageal cancer or precancerous lesions.Methods:The clinical data of 42 patients diagnosed as early esophageal cancer or precancerous lesions with ESD from January 2015 to September 2018 in our digestive endoscopy center were retrospectively analyzed.According to the treatment of wound after operation,21 cases were divided into observation group(treated with glucocorticoid combined with aluminum phosphate gel)and control group(only spraying aluminum phosphate gel).The incidence of postoperative esophageal stricture was calculated in the two groups.The number of endoscope-guided Savarybougie dilation and stent placement required for postoperative esophageal stricture were calculated.Results:All 42 patients were successfully treated with ESD,and the removal rate was 100%(42/42).Postoperative stenosis occurred in 3 cases in the observation group and 9 cases in the control group.The incidence of stenosis in the observation group was significantly lower than that in the control group(14%,3/21 vs.43%,9/21)(χ~2=4.2,P<0.05).The average times(1 time vs.2 times)and maximum times(2 times vs.7 times)of endoscope-guided Savarybougie dilation in the observation group were lower than those in the control group,and there was no significant difference in the average expansion times between the two groups(P>0.05).No patients in the observation group needed stent placement,and 3 patients in the control group received stent placement because of repeated esophageal stricture after operation.There were no serious complications in both groups,such as gastrointestinal hemorrhage,mediastinal fistula and pleurisy.Conclusion:1.The application of glucocorticoid gel on wounds after esophageal ESD could significantly reduce the incidence of postoperative stenosis.2.It is safe to spray glucocorticoid gel on wounds after esophageal ESD.It does not increase the occurrence of severe complications such as bleeding,mediastinal fistula and pleurisy.