Clin Endosc.  2013 Nov;46(6):643-646.

Intralesional Steroid Injection to Prevent Stricture after Near-Circumferential Endosopic Submucosal Dissection for Superficial Esophageal Cancer

Affiliations
  • 1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. hyjung@amc.seoul.kr

Abstract

Stricture frequently occurs after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma with near- or whole-circumferential mucosal defects, and post-ESD stricture is difficult to treat and usually requires multiple sessions of endoscopic balloon dilatation. Intralesional steroid injection has previously been used to prevent stricture; however, there have been few experiences with this method after near- or whole-circumferential ESD. We present a case of a single session of intralesional steroid injection performed immediately after near-circumferential ESD to prevent post-ESD stricture. After a follow-up period of 6 months, the patient showed good outcome without dysphagia.

Keyword

Injections, intralesional; Esophageal stenosis; Endoscopic submucosal dissection; Esophageal neoplasms

MeSH Terms

Constriction, Pathologic*
Deglutition Disorders
Dilatation
Esophageal Neoplasms*
Esophageal Stenosis
Follow-Up Studies
Humans
Injections, Intralesional

Figure

  • Fig. 1 (A) Upper endoscopy with lugol solution reveals an unstained area in the lower esophagus. The superficial esophageal carcinoma involves almost the whole circumference of the esophageal lumen. (B) Circumferential markings are made by a hook knife just outside the lesion. (C) Precutting is made with a hook knife. (D) Near-circumferential endoscopic submucosal dissection is performed. (E) Triamcinolone is injected into the deep submucosa and the superficial proper muscle layer of the ulcer base. (F) The tumor is removed en bloc.

  • Fig. 2 (A) Follow-up esophagography 4 weeks later reveals minimal segmental luminal narrowing (arrow) without passage disturbance. (B) Follow-up endoscopy 4 months later shows only a scar (arrow).


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