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向病灶内注射类固醇可以预防早期食管癌内镜下黏膜下剥离术后狭窄:一对照前瞻性研究

发布日期:2014-1-29 12:40:58 文章来源:GIE 作者次数:1757
    1早期食管癌---指侵犯粘膜或粘膜下层的癌,未侵犯肌层,无淋巴结转移者,多为原位癌或粘膜内癌。

    *                               1日本大阪癌症和心血管疾病医学中心胃肠肿瘤科

    *                               2日本大阪大阪癌症和心血管疾病医学中心肿瘤控制和统计中心肿瘤流行病学和预防科

    *                               摘要

    背景和研究目的:内镜粘膜下剥离术(ESD)治疗食道鳞状细胞癌伴周长超过四分之三的粘膜缺损后,其引起狭窄的发生频率是70% - 90%。狭窄会降低生活质量并且需要多次内镜下球囊扩张(EBD)。我们研究单次灶内注射类固醇对预防ESD后狭窄的疗效和安全性。

    患者和研究方法:我们对30例接受ESD治疗的食管鳞状细胞癌患者进行了一项前瞻性研究这些患者有超过四分之三的但不到整个圆周的粘膜缺陷。ESD后立即进行单次灶内类固醇注射。

    对被报道有吞咽困难的患者和ESD2个月无吞咽困难的患者行食管、胃和十二指肠镜检查。将研究所得结果与历史对照组结果相比较,在历史对照组中,有29例患者接受了ESD治疗,且无病灶内类固醇注射。首要终点是ESD 后狭窄发生率。次要终点是EBD 次数和并发症发生率。

    结果与历史对照组相比究组患者狭窄发生率显著降低10%3/30例)和66%19/29P < 0.0001), EBD 次数降低中位数为0范围:0 – 2中位数为2,范围:0 – 15P < 0.0001)。研究组并发症发生率为7%2/30患者)包括1例有黏膜下裂缝,1例出血,这些都不是EBD直接导致。

    结论 单词类固醇灶内注射可能预防食管癌ESD后狭窄发生。


     

    Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study

                           1Department of Gastrointestinal Oncology, OsakaMedicalCenterfor Cancer and Cardiovascular Diseases,Osaka,Japan

                            2Department of Cancer Epidemiology andPreventionCenterfor Cancer Control and Statistics,OsakaMedicalCenterfor Cancer and Cardiovascular Diseases,Osaka,Japan

    Abstract

    Background and study aims: The frequency of stricture after endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma with a mucosal defect involving more than three-quarters of the circumference is 70 % - 90 %. Stricture decreases quality of life and requires multiple endoscopic balloon dilation (EBD) sessions. We investigated the efficacy and safety of a single session of intralesional steroid injections to prevent post-ESD stricture.

     

    Patients and methods: We conducted a prospective study on 30 patients with esophageal squamous cell carcinoma treated by ESD, who had a more than three-quarter but less than whole circumferential defect. A single session of intralesional steroid injections was undertaken immediately after ESD.

    Esophagogastroduodenoscopy was performed whenever patients reported dysphagia and 2 months after ESD in patients without dysphagia. Results were compared with a historical control group of 29 patients who underwent ESD without intralesional steroid injection. The primary endpoint was the post-ESD stricture rate. Secondary endpoints were the number of EBD sessions and the complication rate.

    Results: Compared with the historical control group, the study group had a significantly lower stricture rate (10 %, 3 /30 patients vs. 66 %, 19 /29 patients; P < 0.0001) and a lower number of EBD sessions (median 0, range 0 - 2 vs. median 2, range 0 - 15; P < 0.0001). The study group had a complication rate of 7 % (2 /30 patients), comprising a submucosal tear in one patient and bleeding in another, which were not a direct result of EBD.

     

    Conclusions: A single session of intralesional steroid injections showed promising results for the prevention of stricture after ESD for esophageal cancer.

     

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