Prediction of esophageal stricture in patients administered locoregional triamcinolone injections immediately after endoscopic submucosal dissection

Abstract

Background and Aim

Esophageal endoscopic submucosal dissection (ESD) to resect widespread lesions has increased the incidence of strictures, and some patients develop strictures despite receiving prophylactic locoregional triamcinolone injections. This study evaluated the predictive factors for esophageal stricture formation in patients administered prophylactic triamcinolone injections after ESD.

Methods

This was a retrospective observational study. Of 552 consecutive patients who underwent ESD, those who received prophylactic triamcinolone injections immediately after ESD were enrolled. The primary outcome was the predictive factors for esophageal stricture formation in patients administered prophylactic triamcinolone injections.

Results

We evaluated 101 en bloc resections involving 144 lesions in 96 patients. Strictures occurred following 17 (16.8%) resections. Wider circumferential mucosal defect (odds ratio [OR] 2.42, 95% confidence interval [CI]: 1.01–5.80; p = 0.048) was an independent predictive factor for stricture development. The cut-off value associated with stricture formation was five-sixths of the circumferential mucosal defect. Propensity analysis determined that the frequency of esophageal strictures increased in patients with circumferential mucosal defects of more than five-sixths compared with those less than five-sixths (OR 5.70, 95% CI: 1.61–20.18; p = 0.007).

Conclusions

Resections involving circumferential mucosal defects of more than five-sixths increased the likelihood of stricture formation in patients administered prophylactic locoregional triamcinolone injections after esophageal ESD.

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