Useful strategies to prevent severe stricture after endoscopic submucosal dissection for superficial esophageal neoplasm

Kaname Uno, Katsunori Iijima, Tomoyuki Koike, Tooru Shimosegawa

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

The minimal invasiveness of endoscopic submucosal dissection (ESD) prompted us to apply this technique to large-size early esophageal squamous cell carcinoma and Barrett's adenocarcinoma, despite the limitations in the study population and surveillance duration. A post-ESD ulceration of greater than three-fourths of esophageal circumference was advocated as an important risk factor for refractory strictures that require several sessions of dilation therapy. Most of the preoperative conditions are asymptomatic, but dilatation treatment for dysphagia associated with the stricture has potential risks of severe complications and a worsening of quality of life. Possible mechanisms of dysphasia were demonstrated based on dysmotility and pathological abnormalities at the site: (1) delayed mucosal healing; (2) severe inflammation and disorganized fibrosis with abundant extracellular matrices in the submucosa; and (3) atrophy in the muscularis proper. However, reports on the administration of anti-scarring agents, preventive dilation therapies, and regenerative medicine demonstrated limited success in stricture prevention, and there were discrepancies in the study designs and protocols of these reports. The development and consequent long-term assessments of new prophylactic technologies on the promotion of wound healing and control of the inflammatory/tumor microenvironment will require collaboration among various research fields because of the limited accuracy of preoperative staging and high-risk of local recurrence.

Original languageEnglish
Pages (from-to)7120-7133
Number of pages14
JournalWorld Journal of Gastroenterology
Volume21
Issue number23
DOIs
Publication statusPublished - 2015 Jun 21

Keywords

  • Dysphasia
  • Endoscopic submucosal dissection
  • Esophageal stricture

ASJC Scopus subject areas

  • Gastroenterology

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