Post written by Yoshiaki Ando, MD, Minoru Kato, MD, and Ryu Ishihara, MD, PhD, from the Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

Several studies have reported a high incidence of stricture after endoscopic submucosal dissection (ESD) in the cervical esophagus. However, the detailed clinical features have not been elucidated. We therefore analyzed 100 patients who underwent ESD for superficial cervical esophageal cancer to elucidate the risk factors of stricture and evaluate the efficacy of local steroid injection for stricture prevention.

Studies have shown that a mucosal defect of >3/4 of the esophageal circumference was a risk factor for stricture after endoscopic resection. Yet, those studies included very few lesions located in the cervical esophagus. Thus, the results mainly reflected lesions located in the thoracic esophagus.

We found that a post-ESD mucosal defect of >1/2 of the esophageal circumference was a risk factor for developing strictures in the cervical esophagus. We also discovered that local steroid injection reduces the risk of stricture in patients with mucosal defects of <3/4 of the esophageal circumference.

However, when the mucosal defect is >3/4 of the circumference, local steroid injection seemed to be insufficient to prevent stricture. Our findings suggest that local steroid injection should be actively performed after ESD in the cervical esophagus when the mucosal defect becomes >1/2 of the esophageal circumference, and that additional approaches (eg, oral steroid administration) might be needed when the mucosal defect becomes >3/4.

Study flow diagram. ESD, Endoscopic submucosal dissection; Pts, patients.

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