Steroid injection and polyglycolic acid shielding to prevent stricture after esophageal endoscopic submucosal dissection: a retrospective comparative analysis (with video)
Steroid injection and polyglycolic acid shielding to prevent stricture after esophageal endoscopic submucosal dissection: a retrospective comparative analysis (with video)
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DOI：
10.1016/j.gie.2020.04.070
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发表时间：
2020-12-01
影响因子：
7.7
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Sakaguchi, Yoshiki;Tsuji, Yosuke;Koike, Kazuhiko
背景和目的：扩张性食管内镜粘膜下剥离术（ESD）术后狭窄是一种严重的不良事件。先前的单组报告表明，聚乙醇酸（PGA）屏蔽可预防狭窄。本研究旨在通过比较分析评估该方法的有效性。方法：这是对2002年至2018年在东京大学医院进行的500例食管ESD的回顾性分析。2013年后，诊断为浅表食管癌（覆盖食管周长的一半以上）的患者在ESD后接受了PGA屏蔽或类固醇注射+ PGA屏蔽的预防性治疗。通过多因素Logistic回归分析评估这些方法预防ESD术后狭窄的有效性。结果：颈段食管术后狭窄的风险尤其高（比值比[OR]，4.60; 95%置信区间[CI]，0.65-61.09）和全环切除术后（OR，3.58x10（3）; 95%CI下限，>185）。类固醇注射+ PGA屏蔽是预防狭窄的唯一显著有效方法（OR，0.30; 95% CI，0.10-0.78; P = 0.009）。在相对低风险亚组（不包括颈段食管癌和完全环切术）中，类固醇注射+ PGA屏蔽与PGA屏蔽与对照组的术后狭窄率分别为18.9%、41.4%和51.7%（P = 0.015）。然而，这种疗效是有限的，在极高risk cases.Conclusion：类固醇注射和PGA屏蔽的组合是有效的，以防止ESD后狭窄。对于颈段食管癌，需要更有效的方法和完整的环形切除术。
Background and Aims: Postoperative stricture after expansive esophageal endoscopic submucosal dissection (ESD) is a severe adverse event. Previous single-arm reports have suggested that polyglycolic acid (PGA) shielding may prevent stricture. This study was performed to assess the efficacy of this method through a comparative analysis.Methods: This is a retrospective analysis of 500 consecutive cases of esophageal ESD performed between 2002 and 2018 at the University of Tokyo Hospital. After 2013, patients with a diagnosis of superficial esophageal carcinoma covering more than half of the esophageal circumference underwent preventive treatment with either PGA shielding or steroid injection + PGA shielding after ESD. The efficacy of these methods for preventing post-ESD stricture was assessed through multivariable logistic regression analysis.Results: The risk of postoperative stricture was especially high in the cervical esophagus (odds ratio [OR], 4.60; 95% confidence interval [CI], 0.65-61.09) and after total circumferential resection (OR, 3.58x10(3); lower bound of 95% CI, >185). Steroid injection + PGA shielding was the only method significantly effective in preventing stricture (OR, 0.30; 95% CI, 0.10-0.78; P = .009). In the relatively low-risk subgroup (excluding cervical esophageal cancer and complete circumferential resection), the postoperative stricture rates for steroid injection + PGA shielding versus PGA shielding versus control were 18.9% versus 41.4% versus 51.7%, respectively (P = .015). However, the efficacy of this was limited in extremely high-risk cases.Conclusion: The combination of steroid injection and PGA shielding is effective for preventing post-ESD stricture. There is a need for even more effective methods for cervical esophageal cancer and complete circumferential resection.