Objective To investigate the efficacy of glucocorticoid combined with temporary stent placement in preventing esophageal stenosis after circumferential or near circumferential endoscopic submucosal dissection (ESD).
Methods Patients received circumferential or near circumferential ESD in People′s Hospital of Yaozhou District in Tongchuan City of Shaanxi Province from January 2019 to June 2021were prospectively included in the study. After ESD, the fully covered stent was attached to the surgical wound, and the stent was removed 6 to 8 weeks after operation. All the patients took prednisone orally from the 3rd day after operation, and then the dosage gradually reduced to the end of the 8th week. According to the situation of temporary stent placement, the patients were divided into stent placement group and non-stent placement group. The age, gender, preoperative pathological results, lesion location, length of longitudinal mucosal defect after ESD and the range of lesion around the esophagus were collected in all the patients; the number of endoscopic balloon dilation (EBD) in patients with esophageal stenosis was recorded; adverse reactions that may be related to hormone administration were recorded. Efficiency of temporary stent placement in preventing esophageal stenosis after ESD was analyzed; the factors affecting the efficacy of stenosis prevention measures were analyzed as well.
Results Finally, a total of 36 patients were included in this study, including 26 patients in the stent placement group and 10 patients in the non-stent placement group. In the stent placement group, the average follow-up was (13.7±4.5) months, the incidence of esophageal stenosis was 38.5% (10/26), and the average number of EBD was (5.5±3.3) times; in the non-stent placement group, the incidence of esophageal stenosis was 90.0% (9/10), and the average number of EBD was (10.5±4.3) times. The incidence of stenosis and the number of ESD in the non-stent placement group were significantly higher than those in the stent placement group (P < 0.01). Patients with pathological result confirmed as squamous cell carcinoma, the longer longitudinal defect of mucosa after ESD was, and the higher incidence rate of postoperative esophageal stenosis was in patients with focus range involved the whole esophagus, and the differences were statistically significant (P < 0.05).
Conclusion Temporary stent placement combined with glucocorticoids is effective and feasible in reducing incidence of stenosis and improving quality of life after circumferential or near circumferential ESD.
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