Efficacy of Combination Therapy of Local Triamcinolone Injection and Oral Prednisolone Administration for Stricture...

Endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) has enabled en bloc resection of large lesions; however, post-ESD esophageal stricture remains an unresolved issue. Particularly, the standard steroid triamcinolone injection (LTI) therapy alone is insufficient for ≥ 7/8 circumferential mucosal defects (non-circumferential) after ESD. Thus, we aimed to compare the efficacy of LTI with a combination therapy of LTI and oral prednisolone administration (OPA).

Between January 2010 and December 2020, we enrolled patients with post-ESD mucosal defects involving seven-eighths or more of the circumference of the esophagus but not circumferential, who had received LTI or a combination therapy of LTI and OPA as prophylactic treatment. Esophageal stricture was defined as a case where an ordinary-sized endoscope could not pass through the post-ESD site, thus requiring endoscopic balloon dilation (EBD) repeatedly until relief of the stricture was achieved. We retrospectively compared LTI and a combination of LTI and OPA in terms of stricture-free survival, stricture rate, and refractory stricture (requiring ≥ 6 EBD procedures) rate.

Overall, 42 and 26 patients in the LTI and combination group were enrolled. The stricture and refractory stricture rates were 42.9% and 16.7% in the LTI group and 26.9% and 15.4% in the combination group, respectively. The SFS rates at 12 weeks were 64.3% and 76.9% in the LTI group and the combination group, respectively.

This study suggested that the combination therapy of LTI and OPA for ≥ 7/8 circumferential mucosal defects (non-circumferential) post-ESD may be useful for preventing strictures.