Novel method to prevent gastric antral strictures after endoscopic submucosal dissection: using triamcinolone

Area of Science:

• Gastroenterology
• Surgical Innovation
• Endoscopic Procedures

Background:

• Endoscopic submucosal dissection (ESD) for large gastric lesions, particularly in the antrum, frequently results in severe gastric strictures.
• Existing treatments for gastric strictures, such as balloon dilation and steroid injections, have limitations and can decrease quality of life.

Observation:

• A novel method using a mixed solution of triamcinolone (MST) injected submucosally during ESD was developed to prevent severe gastric strictures.
• The MST comprises triamcinolone acetonide, glycerol, hyaluronic acid, indigo carmine, and epinephrine, used to elevate the submucosa during the procedure.

Findings:

• The MST method suppresses initial inflammation at the ulcer site, preventing strictures without obstructive symptoms.
• This technique avoids the need for repeated balloon dilation and offers a safe, gentle alternative to current treatments.
• Two cases demonstrated successful prevention of severe gastric antrum strictures post-circumferential ESD using MST, with no complications.

Implications:

• The MST method presents a promising, less invasive approach to managing potential complications from gastric ESD.
• This technique may improve patient outcomes and reduce healthcare burdens associated with gastric stricture treatment.
• Further research could validate MST as a standard preventative measure in gastric ESD procedures.