Impact of topical budesonide on prevention of esophageal stricture after mucosal resection

Published on Dec 9, 2020in Gastrointestinal Endoscopy6.89
· DOI :10.1016/J.GIE.2020.11.026
Michael J. Bartel12
Estimated H-index: 12
(Fox Chase Cancer Center),
Omar Y. Mousa7
Estimated H-index: 7
(Mayo Clinic)
+ 6 AuthorsMichael B. Wallace86
Estimated H-index: 86
(Mayo Clinic)
Sources
Abstract
Background and Aims EMR and endoscopic submucosal dissection (ESD) are treatment modalities for Barrett’s esophagus involving high-grade dysplasia or early cancer. Injectional corticosteroid therapy decreases the risk of procedure-related esophageal stricture (ES) formation. Our aim was to assess the efficacy of topical budesonide on the rate of ES formation after EMR or ESD. Methods Patients included prospectively from 3 tertiary endoscopy centers received 3 mg budesonide orally twice a day for 8 weeks after esophageal EMR or ESD of 50% or more of the esophageal circumference between January 1, 2014 and June 30, 2018. These patients were matched (1:3 ratio) retrospectively with a consecutive patient cohort who underwent EMR or ESD of 50% or more of the esophageal circumference without concomitant corticosteroid therapy. The primary endpoint was the presence of ES at the 12-week follow-up. Results Twenty-five patients (budesonide) were matched with 75 patients (no budesonide). Most underwent EMR for Barrett’s esophagus with biopsy-proven high-grade dysplasia or suspected T1a cancer. Although most baseline characteristics did not differ significantly, patients in the budesonide cohort tended to have a higher proportion of circumferential EMR. The proportion of patients with ES was not significantly lower in the budesonide cohort (16% vs 28%). On logistic regression analysis, budesonide remained associated with a lower incidence of ES (P = .023); however, when controlling for baseline characteristics with a propensity score weighted logistic regression model, there was no significant effect on ES formation (P = .176). Conclusions Topical budesonide might be associated with a reduction of ES after EMR or ESD; however, further studies are needed to verify our results.
References13
Newest
#1Jiahui Yang (Xi'an Jiaotong University)H-Index: 2
#2Xin Wang (Xi'an Jiaotong University)H-Index: 8
Last. Shuixiang He (Xi'an Jiaotong University)H-Index: 15
view all 11 authors...
BACKGROUND AND AIM: Even though endoscopic submucosal dissection is an important endoscopic resection technique for gastrointestinal neoplasms, there are chances that postoperative esophageal stricture might take place as a side effect. Steroid applications were reported to be effective for the prevention of stricture formation. Therefore, this study aims to evaluate the efficacy and safety of different steroid applications. METHODS: Eligible studies published on PubMed, the Cochrane Library, Em...
9 CitationsSource
#1Farzan F. Bahin (Westmead Hospital)H-Index: 15
#2Mahesh Jayanna (Westmead Hospital)H-Index: 7
Last. Michael J. Bourke (USYD: University of Sydney)H-Index: 57
view all 5 authors...
Background and aims: Complete endoscopic resection (CER) of short-segment Barrett’s esophagus with high grade dysplasia (HGD) and early esophageal adenocarcinoma (EEA) is a precise staging tool and achieves durable disease control. The major drawback is development of post-endoscopic resection esophageal stricture (PERES). No effective therapy to prevent PERES has been described. Viscous budesonide slurry (VBS) may have a role in the prevention of PERES by suppressing the post-CER inflammatory p...
23 CitationsSource
#1Wenjin Wang (Lanzhou University)H-Index: 1
#2Zhiyuan MaH-Index: 1
Esophageal stricture is a severe adverse event after circumferential endoscopic submucosal dissection (ESD). Steroid administration is a new method to prevent stricture formation. We performed a meta-analysis to investigate the efficacy and safety of steroid administration to prevent esophageal stricture after circumferential ESD. PubMed, the Cochrane Library, EMBASE, Chinese Biomedical Database, and Clinicaltrials.gov were searched. Studies on steroid administration + endoscopic balloon dilatio...
28 CitationsSource
#1Noboru HanaokaH-Index: 23
#2Ryu IshiharaH-Index: 6
Last. Yuri ItoH-Index: 29
view all 13 authors...
Background and study aims: The frequency of stricture after endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma with a mucosal defect involving more than three-quarters of the circumference is 70 % – 90 %. Stricture decreases quality of life and requires multiple endoscopic balloon dilation (EBD) sessions. We investigated the efficacy and safety of a single session of intralesional steroid injections to prevent post-ESD stricture. Patients and methods: We conducted a pr...
154 CitationsSource
#1Satoru Hashimoto (Niigata University)H-Index: 14
#2Masaaki Kobayashi (Niigata University)H-Index: 19
Last. Yutaka Aoyagi (Niigata University)H-Index: 45
view all 6 authors...
Background Use of endoscopic submucosal dissection (ESD) for management of widespread superficial esophageal carcinomas may be complicated by the development of severe strictures, which may require serial treatment with endoscopic balloon dilatation (EBD). Objective The goal of this study was to determine the efficacy of endoscopic triamcinolone injection (ETI) for the prevention of stricture formation after ESD. Design Case series. Setting Tertiary-care referral center. Patients A total of 41 c...
197 CitationsSource
#1Jason J. Lewis (UM: University of Michigan)H-Index: 3
#2Joel H. RubensteinH-Index: 41
Last. Cyrus Piraka (UM: University of Michigan)H-Index: 19
view all 6 authors...
Background EMR for early neoplastic Barrett's esophagus is gaining favor over esophagectomy. Esophageal stricture development has been reported as a common complication of EMR, photodynamic therapy, and combination endoscopic therapy. Objective To determine clinical and procedural predictors of symptomatic stricture formation after EMR. Design Retrospective analysis. Setting Tertiary-care referral university hospital. Patients Data were retrospectively reviewed on 73 patients at our institution ...
51 CitationsSource
#1Naoyuki Yamaguchi (Nagasaki University)H-Index: 21
#2Hajime Isomoto (Nagasaki University)H-Index: 55
Last. Kazuhiko Nakao (Nagasaki University)H-Index: 55
view all 10 authors...
Background Endoscopic submucosal dissection (ESD) permits en bloc removal of superficial esophageal squamous cell carcinoma . However, postprocedure stricture is common after ESD for extensive tumors, and multiple endoscopic balloon dilation (EBD) is required for recalcitrant cases. Objective To evaluate the effectiveness of oral prednisolone in controlling postprocedure esophageal stricture. Design Retrospective study. Setting Endoscopy department at a university hospital. Patients Patients who...
187 CitationsSource
#1Ranjan Dohil (UCSD: University of California, San Diego)H-Index: 29
#2Robert O. NewburyH-Index: 28
Last. Seema S. AcevesH-Index: 40
view all 5 authors...
Background & Aims Eosinophilic esophagitis (EoE) is caused by immunologic reactions to ingested/inhaled allergens. The diagnosis is considered if ≥15 eosinophils per high-powered field (eos/hpf) are detected in mucosal biopsies. Placebo-controlled studies have not been conducted to evaluate the safety and efficacy of oral viscous budesonide (OVB). Methods Children with EoE were randomly assigned to groups that were given OVB (n = 15) or placebo (n = 9). Patients Results Thirteen (86.7%) children...
462 CitationsSource
#1Satoshi Ono (UTokyo: University of Tokyo)H-Index: 28
#2Mitsuhiro Fujishiro (UTokyo: University of Tokyo)H-Index: 64
Last. Masao Omata (UTokyo: University of Tokyo)H-Index: 128
view all 7 authors...
Background The long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms (ESCNs) have not been evaluated to date. Objective Assess the long-term outcomes of ESD for ESCNs from our consecutive cases. Design and Setting Retrospective study from a single institution. Patients and Intervention From January 2002 to July 2008, 107 superficial ESCNs in 84 patients were treated by ESD. The enrolled patients were divided into 2 groups based on the les...
384 CitationsSource
#1H. MizutaH-Index: 1
#2I. NishimoriH-Index: 1
Last. S. OnishiH-Index: 2
view all 6 authors...
SUMMARY Endoscopic submucosal dissection (ESD) has been utilized as an alternative treatment to endoscopic mucosal resection for superficial esophageal cancer. We aimed to evaluate the complications associated with esophageal ESD and elucidate predictive factors for post-ESD stenosis. The study enrolled a total of 42 lesions of superficial esophageal cancer in 33 consecutive patients who underwent ESD in our department. We retrospectively reviewed ESD-associated complications and comparatively a...
164 CitationsSource
Cited By1
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#1Rui Wu (Nanjing Medical University)H-Index: 1
#2Lili Zhao (Nanjing Medical University)H-Index: 4
Last. Zhining Fan (Nanjing Medical University)H-Index: 15
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Source
#1Daniel Mathies (University of Bonn)
#2Tsuneo OyamaH-Index: 28
Last. Franz Ludwig Dumoulin (University of Bonn)H-Index: 28
view all 4 authors...
Background Endoscopic resection is the treatment of choice for early esophageal cancers. However, resections comprising more than 70-80 % of the circumference are associated with a high risk of stricture formation. Currently, repetitive local injections and/or systemic steroids are given for prevention. Case report We present here the case of a 78-year-old male patient who had a near circumferential endoscopic submucosal dissection for a pT1a mm, L0, V0, R0, G2 esophageal squamous cell cancer. A...
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