Prophylactic steroid administration for strictures after endoscopic resection of large superficial esophageal squamous cell carcinoma
2016
Background and study aims: One of the major complications after endoscopic
resection (ER) for large superficial esophageal squamous cell carcinoma (ESCC)
is benign esophageal stricture, which can reduce quality of life even if ESCC
achieves a cure without organ resection. Recently, steroid administration has
been reported as a prophylactic treatment to prevent esophageal strictures. This
retrospective study evaluated the stricture rate according to the different
width of mucosal defects due to ER and compared it to that seen with
prophylactic steroid administration. Patients and methods: Between June 2007 and December 2013, we enrolled
patients with ESCC who had 3/4 or larger circumferential mucosal defects due to
ER. In December 2009, steroid injections (triamcinolone acetonide 50 mg) into
the ulcer bed due to ER were introduced. Beginning in November 2012, we
commenced oral steroid administration (prednisolone 30 mg/day, tapered gradually
for 8 weeks) in addition to steroid injection. Patients were classified into 3
groups according to the width of mucosal defect after ER (Group A, ≥ 3/4 and
< 7/8; Group B, ≥ 7/8 and less than the entire circumference; and Group C,
the entire circumference). We retrospectively evaluated the stricture rate by
comparing no treatment, steroid injection, or steroid injection followed by oral
steroid according to the width of mucosal defect. Results: A total of 115 patients met the selection criteria. In Group B,
no treatment had a significantly higher stricture rate (100 %, vs. steroid
injection: 56 % P = 0.015; vs steroid injection followed by oral steroid:
20 % P < 0.001). Conversely, in Group C, the stricture rate was high,
regardless of treatment (no treatment: 100 %; steroid injection: 100 %; steroid
injection followed by oral steroid: 71 %). Conclusions: Although prophylactic steroid administration is effective to
prevent strictures for 7/8 circumference or larger mucosal defects, it is
ineffective for whole-circumference defects. Further investigation is
required.
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