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Esophageal Stricture Prevention after Endoscopic Submucosal Dissection
#MMPMID26949124
Jain D
; Singhal S
Clin Endosc
2016[May]; 49
(3
): 241-56
PMID26949124
show ga
Advances in diagnostic modalities and improvement in surveillance programs for
Barrett esophagus has resulted in an increase in the incidence of superficial
esophageal cancers (SECs). SEC, due to their limited metastatic potential, are
amenable to non-invasive treatment modalities. Endoscopic ultrasound, endoscopic
mucosal resection, and endoscopic submucosal dissection (ESD) are some of the new
modalities that gastroenterologists have used over the last decade to diagnose
and treat SEC. However, esophageal stricture (ES) is a very common complication
and a major cause of morbidity post-ESD. In the past few years, there has been a
tremendous effort to reduce the incidence of ES among patients undergoing ESD.
Steroids have shown the most consistent results over time with minimal
complications although the preferred mode of delivery is debatable, with both
systemic and local therapy having pros and cons for specific subgroups of
patients. Newer modalities such as esophageal stents, autologous cell sheet
transplantation, polyglycolic acid, and tranilast have shown promising results
but the depth of experience with these methods is still limited. We have
summarized case reports, prospective single center studies, and randomized
controlled trials describing the various methods intended to reduce the incidence
of ES after ESD. Indications, techniques, outcomes, limitations, and reported
complications are discussed.
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