Efficacy of local injection of triamcinolone and oral methylprednisolone in preventing stricture formation after endoscopic submucosal dissection in early esophageal cancer / 中华消化杂志

ABSTRACT

Objective To compare the efficacy and safety between local injection of triamcinolone and oral methylprednisolone in preventing esophageal stricture formation after endoscopic submucosal dissection (ESD) in patients with early esophageal cancer.Methods From January 2014 to January 2016,67 patients with early esophageal cancer were enrolled,all of them received ESD and were divided into triamcinolone injection group (22 cases),oral methylprednisolone group (22 cases) and control group (23 cases).Patients of triamcinolone group received injection of triamcinolone at injured mucosal under endoscope immediately after ESD.Patients of oral methylprednisolone group took methylprednisolone 30 mg per day since the third day after ESD,and then dosage reduced 5 mg every other week until drug withdrawal.Patients of control group only received ESD.After operation,gastroendoscopy examination was repeated to evaluate the extent of esophageal stricture.Patients with esophageal stricture were treated with an additional endoscopic balloon dilatation (EBD).The rate of esophageal stricture and the frequency of EBD treatment of the three groups were compared.Chi-square test,Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used for statistical analysis.Results The rates of esophageal stricture of triamcinolone injection group,oral methylprednisolone group and control group were 18.2％ (4/22),13.6％0 (3/22) and 73.9％ (17/23),respectively,and the difference was statistically significant (x2 =22.20,P＜0.01).There was no significant difference in the rates of esophageal stricture between triamcinolone injection group and oral methylprednisolone group (x2 =0.17,P=0.50),but the rate of esophageal stricture in triamcinolone injection group was lower than control group,and the difference was statistically significant (x2 =14.03,P＜0.01);the rate of esophageal stricture in oral rnethylprednisolone group was lower than control group,and the difference was also statistically significant (x2 =16.55,P＜0.01).The median frequency of EBD treatment of triamcinolone injection group,oral methylprednisolone group and control group were 2.1 (range 0 to 4.0),1.6 (range 0 to 3.0) and 6.0 (range 0 to 13.0) times,respectively,and the difference was statistically significant (H =17.80,P ＜ 0.01).There was nosignificant difference in the frequency of EBD treatment between triamcinolone injection group and oralmethylprednisolone group (Z=1.21,P=0.23);but the frequency of EBD treatment in triamcinolone injection group was less than control group,and the difference was statistically significant (Z=4.96,P＜ 0.01);the frequency of EBD treatment in oral methylprednisolone group was less than control group,and the difference was also statistically significant (Z=4.32,P＜0.01).There was no severe adverse effect in the three groups.Conclusions Local injections of triamcinolone and oral methylprednisolone both reduced the rate of esophageal stricture after ESD,and decreased frequency of EBD treatment in patients with esophageal stricture.The two regimens showed equal efficacy and good safety.