Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application  

作　　者：Qing-Xia Wang Yuan Ding Qi-Liu Qian Yin-Nan Zhu Rui-Hua Shi 

机构地区：[1]Department of Gastroenterology,Southeast University Affiliated Zhongda Hospital,Medical School,Nanjing 210009,Jiangsu Province,China

出　　处：《World Journal of Gastrointestinal Endoscopy》2024年第9期509-518,共10页世界胃肠内镜杂志（英文版）（电子版）

基　　金：Supported by Jiangsu Province Chinese Medicine Science and Technology Development Program,No.ZT202119.

摘　　要：BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophageal strictures,particularly local injection of triamcinolone acetonide(TA),is a relatively effective method to prevent esophageal strictures.However,even with steroid prophylaxis,stenosis still occurs in up to 45%of patients.Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients.AIM To identify the predictors of esophageal strictures after steroids application.METHODS Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion-and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study.The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis.RESULTS A total of 120 patients were included in the analysis.In the oral prednisone and oral prednisone combined with local tretinoin injection groups,the stenosis rates were 44/53(83.0%)and 56/67(83.6%),respectively.Among them,univariate analysis showed that the lesion circumference(P=0.01)and submucosal injection solution(P=0.04)showed significant correlation with the risk of stenosis formation.Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports,such as additional chemoradiotherapy and tumor location.We identified a lesion circumference<5/6(OR=0.19;P=0.02)and submucosal injection of sodium hyaluronate(OR=0.15;P=0.03)as independent predictors of on esophageal stricture formation.CONCLUSION Steroid prophylaxis effectively prevents stenosis.Moreover,the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esopha

关 键 词：Endoscopic submucosal dissection Esophageal stricture Oral steroids Triamcinolone acetonide PREDICTORS 

分 类 号：R571[医药卫生—消化系统]