Steroid lifting method during endoscopic submucosal dissection: A novel strategy for stricture prevention

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Barrett's esophagus (BE) with high-grade dysplasia (HGD) poses a risk for esophageal cancer.
• Endoscopic submucosal dissection (ESD) is a treatment option for BE-HGD, but large resections increase stricture risk.
• Current preventive strategies for strictures after BE ESD are not well-established.

Observation:

• A 73-year-old male with long BE and HGD underwent a large circumferential ESD.
• A novel "steroid lifting method" using submucosal injection was employed during ESD to mitigate stricture risk.
• The procedure was completed without adverse events, and the patient was discharged on day 4.

Findings:

• Pathological examination confirmed radical resection of multifocal HGD.
• The patient experienced no stricture, dysphagia, or recurrence of BE at 24-month follow-up.
• The "steroid lifting method" demonstrated efficacy in preventing post-ESD stricture in this BE case.

Implications:

• The "steroid lifting method" may be a viable option for preventing strictures after large BE ESD.
• Further large prospective studies are needed to validate this technique and establish optimal preventive measures for BE ESD.
• This approach could improve outcomes for patients undergoing extensive endoscopic treatment for BE-HGD.