Skip to main content
Erschienen in: Digestive Diseases and Sciences 3/2014

01.03.2014 | Original Article

Preventing Stricture Formation by Covered Esophageal Stent Placement After Endoscopic Submucosal Dissection for Early Esophageal Cancer

verfasst von: Jing Wen, Yunsheng Yang, Qingsen Liu, Jing Yang, Shufang Wang, Xiangdong Wang, Hong Du, Jiangyun Meng, Hongbin Wang, Zhongsheng Lu

Erschienen in: Digestive Diseases and Sciences | Ausgabe 3/2014

Einloggen, um Zugang zu erhalten

Abstract

Objective

We aimed to evaluate the efficacy and safety of fully covered esophageal stent placement for preventing esophageal strictures after endoscopic submucosal dissection (ESD).

Methods

Twenty-two patients with a mucosal defects that exceeded 75 % of the circumference of the esophagus after ESD treatment for superficial esophageal squamous cell carcinomas were grouped according to the type of mucosal defect and randomized to undergo fully covered esophageal stent placement post-ESD (group A, n = 11) or no stent placement (group B, n = 11). In group A, the esophageal stents were removed 8 weeks post-ESD. Endoscopy was performed when patients reported dysphagia symptoms and at 12 weeks post-ESD in patients without symptoms. Savary–Gilliard dilators were used for bougie dilation in patients experiencing esophageal stricture in both groups, and we compared the rates of post-ESD strictures and the need for bougie dilation procedures.

Results

The proportion of patients who developed a stricture was significantly lower in group A (18.2 %, n = 2) than in group B (72.7 %, n = 8) (P < 0.05). Moreover, the number of bougie dilation procedures was significantly lower in group A (mean 0.45, range 0–3) than in group B (mean 3.9, range 0–17) (P < 0.05). The two patients in group A who experienced stricture also had stent displacement.

Conclusions

Esophageal stents are a safe and effective method of preventing esophageal strictures in cases where >75 % of the circumference of the esophagus has mucosal defects after ESD treatment for early esophageal cancer.
Literatur
1.
Zurück zum Zitat Repici A, Hassan C, Carlino A, et al. Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: result from a prospective western series. Gastrointest Endosc. 2010;71:715–721.PubMedCrossRef Repici A, Hassan C, Carlino A, et al. Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: result from a prospective western series. Gastrointest Endosc. 2010;71:715–721.PubMedCrossRef
2.
Zurück zum Zitat Neuhaus H. Endoscopic submucosal dissection in the upper gastrointestinal tract: present and future view of Europe. Dig Endosc. 2009;21:S4–S6.PubMedCrossRef Neuhaus H. Endoscopic submucosal dissection in the upper gastrointestinal tract: present and future view of Europe. Dig Endosc. 2009;21:S4–S6.PubMedCrossRef
3.
Zurück zum Zitat Radu A, Grosjean P, Fontolliet C, et al. Endoscopic mucosal resection in the oesophagus with a new rigid device: an animal study. Endoscopy. 2004;36:298–305.PubMedCrossRef Radu A, Grosjean P, Fontolliet C, et al. Endoscopic mucosal resection in the oesophagus with a new rigid device: an animal study. Endoscopy. 2004;36:298–305.PubMedCrossRef
4.
Zurück zum Zitat Mizuta H, Nishimori I, Kuratani Y, et al. Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus. 2009;22:626–631.PubMedCrossRef Mizuta H, Nishimori I, Kuratani Y, et al. Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus. 2009;22:626–631.PubMedCrossRef
5.
Zurück zum Zitat Ono S, Fujishiro M, Niimi K, et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy. 2009;41:661–665.PubMedCrossRef Ono S, Fujishiro M, Niimi K, et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy. 2009;41:661–665.PubMedCrossRef
6.
Zurück zum Zitat Katada C, Muto M, Manabe T, et al. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc. 2003;57:165–169.PubMedCrossRef Katada C, Muto M, Manabe T, et al. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc. 2003;57:165–169.PubMedCrossRef
7.
Zurück zum Zitat Ono S, Fujishiro M, Niimi K, et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc. 2009;70:860–866.PubMedCrossRef Ono S, Fujishiro M, Niimi K, et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc. 2009;70:860–866.PubMedCrossRef
8.
Zurück zum Zitat Isomoto H, Yamaguchi N, Nakayama T, et al. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. BMC Gastroenterol. 2011;4:46.CrossRef Isomoto H, Yamaguchi N, Nakayama T, et al. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. BMC Gastroenterol. 2011;4:46.CrossRef
9.
Zurück zum Zitat Yamaguchi N, Isomoto H, Nakayama T, et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2011;73:1115–1121.PubMedCrossRef Yamaguchi N, Isomoto H, Nakayama T, et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2011;73:1115–1121.PubMedCrossRef
10.
Zurück zum Zitat Ezoe Y, Muto M, Horimatsu T, et al. Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol. 2011;45:222–227.PubMedCrossRef Ezoe Y, Muto M, Horimatsu T, et al. Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol. 2011;45:222–227.PubMedCrossRef
11.
Zurück zum Zitat Kim JH, Song HY, Choi EK, et al. Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients. Eur Radiol. 2009;19:384–390.PubMedCrossRef Kim JH, Song HY, Choi EK, et al. Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients. Eur Radiol. 2009;19:384–390.PubMedCrossRef
12.
Zurück zum Zitat Wadhwa RP, Kozarek RA, France RE, et al. Use of self-expandable metallic stents in benign GI diseases. Gastrointest Endosc. 2003;58:207–212.PubMedCrossRef Wadhwa RP, Kozarek RA, France RE, et al. Use of self-expandable metallic stents in benign GI diseases. Gastrointest Endosc. 2003;58:207–212.PubMedCrossRef
13.
Zurück zum Zitat Song HY, Park SI, Do YS, et al. Expandable metallic stent placement in patients with benign esophageal strictures: results of long-term follow-up. Radiology. 1997;203:131–136.PubMedCrossRef Song HY, Park SI, Do YS, et al. Expandable metallic stent placement in patients with benign esophageal strictures: results of long-term follow-up. Radiology. 1997;203:131–136.PubMedCrossRef
14.
Zurück zum Zitat Cheng YS, Li MH, Chen WX, et al. Temporary partially-covered metal stent insertion in benign esophageal stricture. World J Gastroenterol. 2003;9:2359–2361.PubMed Cheng YS, Li MH, Chen WX, et al. Temporary partially-covered metal stent insertion in benign esophageal stricture. World J Gastroenterol. 2003;9:2359–2361.PubMed
15.
Zurück zum Zitat Matsumoto S, Miyatani H, Yoshida Y, et al. Cicatricial stenosis after endoscopic submucosal dissection of esophageal cancer effectively treated with a temporary self-expandable metal stent. Gastrointest Endosc. 2011;73:1309–1312.PubMedCrossRef Matsumoto S, Miyatani H, Yoshida Y, et al. Cicatricial stenosis after endoscopic submucosal dissection of esophageal cancer effectively treated with a temporary self-expandable metal stent. Gastrointest Endosc. 2011;73:1309–1312.PubMedCrossRef
16.
Zurück zum Zitat Hashimoto S, Kobayashi M, Manabu T, et al. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc. 2011;74:1389–1393.PubMedCrossRef Hashimoto S, Kobayashi M, Manabu T, et al. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc. 2011;74:1389–1393.PubMedCrossRef
17.
Zurück zum Zitat Hanaoka N, Ishihara R, Takeuchi Y, et al. Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy. 2012;44:1007–1011.PubMedCrossRef Hanaoka N, Ishihara R, Takeuchi Y, et al. Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy. 2012;44:1007–1011.PubMedCrossRef
18.
Zurück zum Zitat Uno K, Iijima K, Koike T, et al. A pilot study of scheduled endoscopic balloon dilation with oral agent tranilast to improve the efficacy of stricture dilation after endoscopic submucosal dissection of the esophagus. J Clin Gastroenterol. 2012;46:e76–e82.PubMedCrossRef Uno K, Iijima K, Koike T, et al. A pilot study of scheduled endoscopic balloon dilation with oral agent tranilast to improve the efficacy of stricture dilation after endoscopic submucosal dissection of the esophagus. J Clin Gastroenterol. 2012;46:e76–e82.PubMedCrossRef
19.
Zurück zum Zitat Mizutani T, Tadauchi A, Arinobe M, et al. Novel strategy for prevention of esophageal stricture after endoscopic surgery. Hepatogastroenterology. 2010;57:1150–1156.PubMed Mizutani T, Tadauchi A, Arinobe M, et al. Novel strategy for prevention of esophageal stricture after endoscopic surgery. Hepatogastroenterology. 2010;57:1150–1156.PubMed
20.
Zurück zum Zitat Kim JH, Song HY, Park SW, et al. Early symptomatic strictures after gastric surgery: palliation with balloon dilation and stent placement. J Vasc Interv Radiol. 2008;19:565–570.PubMedCrossRef Kim JH, Song HY, Park SW, et al. Early symptomatic strictures after gastric surgery: palliation with balloon dilation and stent placement. J Vasc Interv Radiol. 2008;19:565–570.PubMedCrossRef
21.
Zurück zum Zitat Dua KS, Vleggaar FP, Santharam R, et al. Removable self-expanding plastic esophageal stent as a continuous, non-permanent dilator in treating refractory benign esophageal stricture: a prospective two center study. Am J Gastroenterol. 2008;103:2988–2994.PubMedCrossRef Dua KS, Vleggaar FP, Santharam R, et al. Removable self-expanding plastic esophageal stent as a continuous, non-permanent dilator in treating refractory benign esophageal stricture: a prospective two center study. Am J Gastroenterol. 2008;103:2988–2994.PubMedCrossRef
22.
Zurück zum Zitat Song HY, Jung HY, Park SI, et al. Covered retrievable expandable nitinol stents in patients with benign esophageal strictures: initial experience. Radiology. 2000;217:551–557.PubMedCrossRef Song HY, Jung HY, Park SI, et al. Covered retrievable expandable nitinol stents in patients with benign esophageal strictures: initial experience. Radiology. 2000;217:551–557.PubMedCrossRef
23.
Zurück zum Zitat Saito Y, Tanaka T, Andoh A, et al. Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci. 2008;53:330–333.PubMed Saito Y, Tanaka T, Andoh A, et al. Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci. 2008;53:330–333.PubMed
24.
Zurück zum Zitat Nieponice A, McGrath K, Qureshi I, et al. An extracellular matrix scaffold for esophageal stricture prevention after circumferential EMR. Gastrointest Endosc. 2009;69:289–296.PubMedCrossRef Nieponice A, McGrath K, Qureshi I, et al. An extracellular matrix scaffold for esophageal stricture prevention after circumferential EMR. Gastrointest Endosc. 2009;69:289–296.PubMedCrossRef
25.
Zurück zum Zitat Ohki T, Yamato M, Ota M, et al. Prevention of esophageal stricture after endoscopic submucosal dissection using tissue-engineered cell sheets. Gastroenterology. 2012;143:582–588.PubMedCrossRef Ohki T, Yamato M, Ota M, et al. Prevention of esophageal stricture after endoscopic submucosal dissection using tissue-engineered cell sheets. Gastroenterology. 2012;143:582–588.PubMedCrossRef
Metadaten
Titel
Preventing Stricture Formation by Covered Esophageal Stent Placement After Endoscopic Submucosal Dissection for Early Esophageal Cancer
verfasst von
Jing Wen
Yunsheng Yang
Qingsen Liu
Jing Yang
Shufang Wang
Xiangdong Wang
Hong Du
Jiangyun Meng
Hongbin Wang
Zhongsheng Lu
Publikationsdatum
01.03.2014
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 3/2014
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-013-2958-5

Weitere Artikel der Ausgabe 3/2014

Digestive Diseases and Sciences 3/2014 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.