Post written by Yoshiki Sakaguchi, MD, PhD, and Yosuke Tsuji, MD, PhD, from the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Postoperative stricture is a severe adverse event, which frequently occurs after resection of over 3/4 the circumference of the esophagus and may require treatment over a long period of time. However, there are no current guidelines on methods to prevent stricture. The focus of our study was to evaluate the efficacy of steroid injection and polyglycolic acid (PGA) shielding, a novel method in the field of endoscopy, in preventing postoperative stricture.
While multiple methods to prevent postoperative esophageal stricture have been introduced, there are few comparative studies assessing the efficacy of each method. In addition, theses comparative studies have demonstrated conflicting results, which may be attributed to the difference in background factors of the patients included in each study. Clarification of risk factors that induce stricture and further comparative studies are necessary in order to compare the pros and cons of each method.
This is the first comparative study demonstrating the efficacy of PGA shielding in preventing stricture. In addition, we have demonstrated that combining steroid injection with PGA shielding further enhances this prophylactic effect.
However, on a negative note, we have also demonstrated that cervical esophageal cancer and complete circumferential resection are risk factors that highly increase the risk of postoperative stricture. While the methods introduced in this study alleviate stricture in these high-risk patients, development of new methods to further decrease the risk of postoperative stricture are required. Future comparative studies with patients stratified based on risk factors should also be considered in order to clarify which methods are the most effective in preventing stricture.
Figure 1. A representative case in which postoperative stricture was alleviated after complete circumferential ESD. A case of complete circumferential squamous cell carcinoma (A). After complete circumferential resection (B), steroid injection plus PGA shielding was performed (C). Endoscopic follow-up was performed regularly thereafter (D–H), with no signs of stricture until day 180 when the patient required 1 session of balloon dilation (I). No dilation was required afterward. POD, postoperative day.
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