Skip to main content
Top
Published in: Digestive Diseases and Sciences 6/2016

Open Access 01-06-2016 | Case Report

Prevention of Esophageal Strictures After Endoscopic Submucosal Dissection: A Promising Therapy Using Carboxymethyl Cellulose Sheets

Authors: Guan Way Lua, Jian Tang, Feng Liu, Zhao Shen Li

Published in: Digestive Diseases and Sciences | Issue 6/2016

Login to get access

Abstract

Background

Esophageal stricture is one of the serious adverse events following endoscopic submucosal dissection (ESD). However, optimum preventive techniques are still lacking.

Aims

Our primary objective was to evaluate the incidence of post-ESD esophageal stricture with the application of carboxymethyl cellulose (CMC) sheets. Secondary objectives were to determine the number of sessions of endoscopic balloon dilatation (EBD) required to resolve post-ESD strictures and the incidence rate of peri-operative adverse events.

Methods

This was a pilot, single-center, prospective study. Seven patients who had high risks of developing post-ESD esophageal stricture were enrolled into our study. CMC sheets were applied to the mucosal defects immediately after the completion of ESD. Patients were monitored and reviewed after ESD to detect any adverse events.

Results

The incidence rate of post-operative stricture was 57 % (4/7 patients). Among patients who required EBD, the number of sessions performed was 2.8 ± 2.2. No serious post-operative adverse events were reported.

Conclusion

The use of CMC sheets appears to be a safe and effective prophylactic treatment for esophageal stricture following extensive ESD.
Appendix
Available only for authorised users
Literature
1.
go back to reference Gotoda T, Kondo H, Ono H, et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc. 1999;50:560–563.CrossRefPubMed Gotoda T, Kondo H, Ono H, et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc. 1999;50:560–563.CrossRefPubMed
2.
go back to reference Isomoto H, Shikuwa S, Yamaguchi N, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–336.CrossRefPubMed Isomoto H, Shikuwa S, Yamaguchi N, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–336.CrossRefPubMed
3.
go back to reference Fujishiro M. Perspective on the practical indications of endoscopic submucosal dissection of gastrointestinal neoplasms. World J Gastroenterol. 2008;14:4289–4295.CrossRefPubMedPubMedCentral Fujishiro M. Perspective on the practical indications of endoscopic submucosal dissection of gastrointestinal neoplasms. World J Gastroenterol. 2008;14:4289–4295.CrossRefPubMedPubMedCentral
4.
go back to reference Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol. 2005;3:S67–S70.CrossRefPubMed Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol. 2005;3:S67–S70.CrossRefPubMed
5.
go back to reference Fujishiro M, Yahagi N, Kakushima N, et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol. 2006;4:688–694.CrossRefPubMed Fujishiro M, Yahagi N, Kakushima N, et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol. 2006;4:688–694.CrossRefPubMed
7.
go back to reference Mizuta H, Nishimori I, Kuratani Y, Higashidani Y, Kohsaki T, Onishi S. Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus. 2009;22:626–631.CrossRefPubMed Mizuta H, Nishimori I, Kuratani Y, Higashidani Y, Kohsaki T, Onishi S. Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus. 2009;22:626–631.CrossRefPubMed
8.
go back to reference Yang F, Ma D, Cai QC, Li ZS. Esophageal strictures after extensive endoscopic submucosal dissection: steroid gel application, the ideal choice? J Gastroenterol Hepatol. 2013;28:1795–1797.CrossRefPubMed Yang F, Ma D, Cai QC, Li ZS. Esophageal strictures after extensive endoscopic submucosal dissection: steroid gel application, the ideal choice? J Gastroenterol Hepatol. 2013;28:1795–1797.CrossRefPubMed
9.
go back to reference American Society of Gastrointestinal Endoscopy. Esophageal dilation. Guidelines for clinical application. Gastrointest Endosc. 1991;37:122–124.CrossRef American Society of Gastrointestinal Endoscopy. Esophageal dilation. Guidelines for clinical application. Gastrointest Endosc. 1991;37:122–124.CrossRef
10.
go back to reference Takahashi H, Arimura Y, Okahara S, et al. Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma. Endoscopy. 2011;43:184–189. doi:10.1055/s-0030-1256109.CrossRefPubMed Takahashi H, Arimura Y, Okahara S, et al. Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma. Endoscopy. 2011;43:184–189. doi:10.​1055/​s-0030-1256109.CrossRefPubMed
11.
go back to reference Hashimoto S, Kobayashi M, Takeuchi M, Sato Y, Narisawa R, Aoyagi Y. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc. 2011;74:1389–1393. doi:10.1016/j.gie.2011.07.070.CrossRefPubMed Hashimoto S, Kobayashi M, Takeuchi M, Sato Y, Narisawa R, Aoyagi Y. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc. 2011;74:1389–1393. doi:10.​1016/​j.​gie.​2011.​07.​070.CrossRefPubMed
12.
go back to reference Yamaguchi N, Isomoto H, Nakayama T, et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2011;73:1115–1121. doi:10.1016/j.gie.2011.02.005.CrossRefPubMed Yamaguchi N, Isomoto H, Nakayama T, et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2011;73:1115–1121. doi:10.​1016/​j.​gie.​2011.​02.​005.CrossRefPubMed
13.
go back to reference Kobayashi S, Kanai N, Ohki T, et al. Prevention of esophageal strictures after endoscopic submucosal dissection. World J Gastroenterol. 2014;20:15098–15109.CrossRefPubMedPubMedCentral Kobayashi S, Kanai N, Ohki T, et al. Prevention of esophageal strictures after endoscopic submucosal dissection. World J Gastroenterol. 2014;20:15098–15109.CrossRefPubMedPubMedCentral
15.
16.
go back to reference Sakaguchi Y, Tsuji Y, Ono S, et al. Polyglycolic acid sheets with fibrin glue can prevent esophageal stricture after endoscopic submucosal dissection. Endoscopy. 2015;47:336–340. ISSN: 1438-8812. Sakaguchi Y, Tsuji Y, Ono S, et al. Polyglycolic acid sheets with fibrin glue can prevent esophageal stricture after endoscopic submucosal dissection. Endoscopy. 2015;47:336–340. ISSN: 1438-8812.
17.
go back to reference Broek RP, Stommel MW, Strik C, van Laarhoven CJ, Keus F, van Goor H. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet. 2014;383:48–59. doi:10.1016/S0140-6736(13)61687-6. Broek RP, Stommel MW, Strik C, van Laarhoven CJ, Keus F, van Goor H. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet. 2014;383:48–59. doi:10.​1016/​S0140-6736(13)61687-6.
18.
go back to reference Risberg B. Adhesions: preventive strategies. Eur J Surg Suppl. 1997;577:32–39.PubMed Risberg B. Adhesions: preventive strategies. Eur J Surg Suppl. 1997;577:32–39.PubMed
19.
go back to reference Huang H, Deng M, Jin H, et al. Preventing intra-abdominal adhesions with a sodium hyaluronate carboxymethylcellulose membrane enabled visualization of hepatic microcirculation. Int J Surg. 2013;11:935–943.CrossRefPubMed Huang H, Deng M, Jin H, et al. Preventing intra-abdominal adhesions with a sodium hyaluronate carboxymethylcellulose membrane enabled visualization of hepatic microcirculation. Int J Surg. 2013;11:935–943.CrossRefPubMed
20.
go back to reference Seeger JM, Kaelin LD, Staples EM, et al. Prevention of postoperative pericardial adhesions using tissue-protective solutions. J Surg Res. 1997;68:63–66.CrossRefPubMed Seeger JM, Kaelin LD, Staples EM, et al. Prevention of postoperative pericardial adhesions using tissue-protective solutions. J Surg Res. 1997;68:63–66.CrossRefPubMed
21.
go back to reference Pang ZC, Xu HQ, Xie WJ. An experimental study on prevention of peridural adhesion after laminectomy. Chin J Repar Reconstr Surg. 2006;20:1176–1179. Pang ZC, Xu HQ, Xie WJ. An experimental study on prevention of peridural adhesion after laminectomy. Chin J Repar Reconstr Surg. 2006;20:1176–1179.
22.
go back to reference Jiang CY, Shu JH, Jiang T, Wang W, Xu YJ. Application of absorbable hemostat in transoral endoscopic adenoidectomy. J Bengbu Med Coll. 2014;39:870–871, 874. Jiang CY, Shu JH, Jiang T, Wang W, Xu YJ. Application of absorbable hemostat in transoral endoscopic adenoidectomy. J Bengbu Med Coll. 2014;39:870–871, 874.
23.
go back to reference Zhang CL, Tian WM, Cui FZ. Evaluation of resorbable barrier for preventing surgical adhesions. Curr Appl Phys. 2005;5:411–416.CrossRef Zhang CL, Tian WM, Cui FZ. Evaluation of resorbable barrier for preventing surgical adhesions. Curr Appl Phys. 2005;5:411–416.CrossRef
24.
go back to reference Tang B, Bai JY, Zhao XY, et al. Endoscopic submucosal dissection for superficial esophageal cancer with near-circumferential lesions: our experience with 40 patients. Surg Endosc. 2015;29:2141–2148. doi:10.1007/s00464-014-3909-8. Tang B, Bai JY, Zhao XY, et al. Endoscopic submucosal dissection for superficial esophageal cancer with near-circumferential lesions: our experience with 40 patients. Surg Endosc. 2015;29:2141–2148. doi:10.​1007/​s00464-014-3909-8.
25.
go back to reference Saito Y, Tanaka T, Andoh A, et al. Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci. 2008;53:330–333.CrossRefPubMed Saito Y, Tanaka T, Andoh A, et al. Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci. 2008;53:330–333.CrossRefPubMed
26.
go back to reference Nieponice A, McGrath K, Qureshi I, et al. An extracellular matrix scaffold for esophageal stricture prevention after circumferential EMR. Gastrointest Endosc. 2009;69:289–296.CrossRefPubMed Nieponice A, McGrath K, Qureshi I, et al. An extracellular matrix scaffold for esophageal stricture prevention after circumferential EMR. Gastrointest Endosc. 2009;69:289–296.CrossRefPubMed
27.
go back to reference Badylak SF, Hoppo T, Nieponice A, Gilbert TW, Davison JM, Jobe BA. Esophageal preservation in five male patients after endoscopic inner-layer circumferential resection in the setting of superficial cancer: a regenerative medicine approach with a biologic scaffold. Tissue Eng Part A. 2011;17:1643–1650.CrossRefPubMedPubMedCentral Badylak SF, Hoppo T, Nieponice A, Gilbert TW, Davison JM, Jobe BA. Esophageal preservation in five male patients after endoscopic inner-layer circumferential resection in the setting of superficial cancer: a regenerative medicine approach with a biologic scaffold. Tissue Eng Part A. 2011;17:1643–1650.CrossRefPubMedPubMedCentral
28.
go back to reference Bahin FF, Jayanna M, Williams SJ, Lee EY, Bourke MJ. Efficacy of viscous budesonide slurry for prevention of esophageal stricture formation after complete endoscopic mucosal resection of short-segment Barrett’s neoplasia. Endoscopy. 2016;48:71–74.CrossRefPubMed Bahin FF, Jayanna M, Williams SJ, Lee EY, Bourke MJ. Efficacy of viscous budesonide slurry for prevention of esophageal stricture formation after complete endoscopic mucosal resection of short-segment Barrett’s neoplasia. Endoscopy. 2016;48:71–74.CrossRefPubMed
29.
go back to reference Takahashi H, Arimura Y, Okahara S, et al. A randomized controlled trial of endoscopic steroid injection for prophylaxis of esophageal stenoses after extensive endoscopic submucosal dissection. BMC Gastroenterol. 2015;15:1.CrossRefPubMedPubMedCentral Takahashi H, Arimura Y, Okahara S, et al. A randomized controlled trial of endoscopic steroid injection for prophylaxis of esophageal stenoses after extensive endoscopic submucosal dissection. BMC Gastroenterol. 2015;15:1.CrossRefPubMedPubMedCentral
Metadata
Title
Prevention of Esophageal Strictures After Endoscopic Submucosal Dissection: A Promising Therapy Using Carboxymethyl Cellulose Sheets
Authors
Guan Way Lua
Jian Tang
Feng Liu
Zhao Shen Li
Publication date
01-06-2016
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 6/2016
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-016-4034-4

Other articles of this Issue 6/2016

Digestive Diseases and Sciences 6/2016 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.