Comparison of statins with steroids and botulinum toxin A in the prevention of benign strictures after esophageal endoscopic submucosal dissection: a retrospective cohort study
Comparison of statins with steroids and botulinum toxin A in the prevention of benign strictures after esophageal endoscopic submucosal dissection: a retrospective cohort study
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DOI：
10.1007/s00464-023-09906-x
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发表时间：
2023-02
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通讯作者：
Yanjuan Wang;Weiyu Xia;L. Tian;Boqian Zhu;Meihong Chen;Xinmin Si;Sheng-li Lin;Yaoyao Gong
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作者：
Yanjuan Wang;Weiyu Xia;L. Tian;Boqian Zhu;Meihong Chen;Xinmin Si;Sheng-li Lin;Yaoyao Gong
背景食管内镜黏膜下剥离术（ESD）后良性狭窄的预防仍然困难，寻找一种安全、有效、简单的治疗方法至关重要。我们先前报道了瑞舒伐他汀显著降低了兔食管狭窄模型中狭窄的发生率和严重程度。因此，在这项研究中，我们比较了他汀类药物，类固醇和肉毒杆菌毒素A（BTX-A）对ESD后狭窄预防的影响，涉及超过四分之三的管腔周长。方法在2015年1月至2020年12月期间治疗的1019例ESD病例中，246例符合纳入标准，21例因失访，肿瘤复发，死亡，或需要额外的手术、放疗和/或化疗。在纳入的225例病例中，145例未接受干预，其余80例接受了治疗：口服类固醇16例，局部注射曲安奈德（TA）20例，局部注射BTX-A 21例，他汀类药物23例（17.4%，4/23）显著低于未干预组（75.2%，109/145，P= 0.000），口服类固醇（56.3%，9/16，P= 0.011）和TA注射（50%，10/20，P= 0.023）组，但与BTX-A注射（38.1%，8/21，P= 0.124）组相当。他汀类药物组吞咽困难评分低于非干预组（P= 0.000）。尽管两组之间所需的扩张次数没有显著差异，但他汀类药物组的最大扩张次数仅为6.ConclusionsStatins可能是预防广泛ESD后食管狭窄的潜在治疗方法;然而，应进行临床试验以验证这一点。
BackgroundPreventing benign strictures following esophageal endoscopic submucosal dissection (ESD) remains difficult, and finding a safe, effective, and simple management method is vital. We previously reported that rosuvastatin significantly reduced the incidence and severity of strictures in a rabbit model of esophageal stricture. Accordingly, in this study, we compared the effects of statins, steroids, and botulinum toxin A (BTX-A) on stricture prevention after ESD involving more than three-fourths of the luminal circumference.MethodsOf the 1019 ESD cases treated between January 2015 and December 2020, 246 met the inclusion criteria, with 21 cases excluded due to loss to follow-up, tumor recurrence, death, or need for additional surgery, radiotherapy, and/or chemotherapy. Of the 225 included cases, 145 received no intervention, while the remaining 80 were treated: 16 with oral steroids, 20 with topical triamcinolone acetonide (TA) injection, 21 with topical BTX-A injection, and 23 with statins.ResultsThe occurrence stricture rate in the statins group (17.4%, 4/23) was significantly lower than in the non-intervention (75.2%, 109/145,P= 0.000), oral steroids (56.3%, 9/16,P= 0.011) and TA injection (50%, 10/20,P= 0.023) groups, but comparable to in the BTX-A injection (38.1%, 8/21,P= 0.124) group. The dysphagia score was lower in the statin than non-intervention group (P= 0.000). Although there was no significant difference in the number of required dilations between groups, the maximum number of dilations in the statins group was only six.ConclusionsStatins may be a potential treatment to prevent esophageal strictures after extensive ESD; however, clinical trials should be conducted to validate this.Graphical abstract