Post written by Muneaki Miyake, MD, from the Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

The focus of our study was to identify predictors of stricture after endoscopic submucosal dissection (ESD) of the esophagus with local triamcinolone (TA) injection.

Local TA injection is widely used to prevent stricture formation after ESD of the esophagus. Despite this prophylactic measure, stricture develops in up to 45% of patients. Identification of predictors of stricture after local TA injection is important because it will allow identification of patients with higher risk of stricture and consideration of additional interventions.

Therefore, we conducted a single-center prospective study. A total of 203 patients were included in the analysis. Multivariate analysis identified residual mucosal width ≤5 mm (odds ratio [OR], 29.0; P < .0001) or 6 to 10 mm (OR, 3.7; P = .04), history of chemoradiotherapy (OR, 5.1; P = .045), and tumor in the cervical or upper thoracic esophagus (OR, 3.8; P = .018) as independent predictors of stricture.

Based on the ORs of the predictors, patients were stratified into 2 groups according to stricture risk: patients in the high-risk group (residual mucosal width ≤5 mm or 6-10 mm with another predictor) had a stricture rate of 52.5% (31 of 59 cases), and patients in the low-risk group (residual mucosal width ≥11 mm or 6-10 mm without other predictors) had a stricture rate of 6.3% (9 of 144 cases).

In conclusion, we identified predictors of stricture after ESD and local TA injection, which prevented stricture formation after ESD in low-risk patients but was not sufficient to prevent stricture in high-risk patients. Additional interventions should thus be considered in high-risk patients.

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