ABSTRACT
BACKGROUND: Endoscopic submucosal dissection (ESD) is rapidly becoming a favored method for removing early esophageal cancer, but the residual defects can be complicated with strictures that require repeated endoscopic balloon dilatation. Measures for preventing the post-ESD strictures have been sought. We conducted a systematic review of recent studies to evaluate these methods. METHODS: We searched MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and Google Scholar until November 30, 2014. Included studies were prospective and retrospective one- and two-arm studies. All studies had to include at least on preventive method for post-ESD stricture. Thirteen studies were included in the review. RESULTS: Among the studies that used corticosteroids to prevent post-ESD stricture, we found that (1) injection of triamcinolone acetonide into the esophageal lesion resulted in a substantial reduction in the rate of stricture, and (2) the use of oral prednisolone was associated with a significantly reduced rate of dilatation sessions and stricture. Studies of other preventative measures included more recently developed scaffold-based and cell-based tissue-engineering approaches which seem very promising but require additional rigorously controlled studies to test their effectiveness. CONCLUSIONS: Until a safer and more effective method is developed, our review supports the use of corticosteroids, either through injection or oral route, together with endoscopic dilatation in prevention of post-ESD strictures.
Subject(s)
Dissection/adverse effects , Esophageal Neoplasms/surgery , Esophageal Stenosis/prevention & control , Mucous Membrane/surgery , Administration, Oral , Anti-Inflammatory Agents/administration & dosage , Dilatation , Dissection/methods , Esophageal Neoplasms/pathology , Esophageal Stenosis/etiology , Esophagoscopy , Humans , Injections, Intralesional , Prednisolone/administration & dosage , Tissue Engineering , Triamcinolone Acetonide/administration & dosageABSTRACT
BACKGROUND AND PURPOSE: To investigate the differences between endoscopic ultrasonography (EUS)-based longitudinal gross target volumes (GTV) (GTV(EUS)) and computed tomography (CT)-based longitudinal GTV (GTV(CT)) in diagnosing esophageal squamous carcinoma. METHODS: Thirty-six patients underwent EUS to define the superior and inferior extents of the tumor by using hemoclips. CT-planning scan was performed with the patient in the supine position during the treatment. GTV(CT) and GTV(EUS) were contoured respectively. The respective lengths (L(CT) and L(EUS)) and spatial locations of longitudinal GTV(CT) and longitudinal GTV(EUS) were compared. RESULTS: The mean LCT was 7.8 ± 3.2 cm and the mean L(EUS) was 7.4 ± 2.7 cm. No statistical difference was found between L(CT) and L(EUS) (P > 0.05) with a correlation coefficient of 0.61 (P<0.05). The mean conformal index was 0.79 ± 0.18 with spatial variations found in 71% (24/34) of the patients. CONCLUSIONS: EUS can provide additional information to CT in defining longitudinal GTV in thoracic esophageal squamous cell carcinoma, especially superficial and submucosal carcinomas, which may contribute to the development of better individual treatment regimens.
Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Endosonography , Esophageal Neoplasms/diagnostic imaging , Radiotherapy Planning, Computer-Assisted/methods , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/radiotherapy , Esophageal Neoplasms/radiotherapy , Esophagoscopy , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
OBJECTIVE: To compare the results of procedure for prolapse and hemorrhoids (PPH) and open hemorrhoidectomy. METHODS: A standard questionnaire was given to all patients after PPH or open hemorrhoidectomy from March 2001 to March 2004. In combination with proctological examination, the results including symptoms relief and recurrence were compared between the two groups. RESULTS: There were 184 effective questionnaires, including 96 cases in PPH group and 88 in open hemorrhoidectomy group. PPH and open hemorrhoidectomy both relieved prolapse (92.7% vs 96.8%, P=0.282), bleeding (91% vs 81%, P=0.241) and pain (91.7% vs 91.5%, P=0.977). There were no statistical differences in the overall complication rate (30.2% and 29.5%, P=0.923) and recurrence rate (21.8% vs 20.5%, P=0.814) between the two groups. The overall satisfactory degree was 87.5% in PPH group and 84.8% in open hemorrhoidectomy group (P=0.218). CONCLUSION: PPH is a safe and effective option for prolapsed hemorrhoids compared with open hemorrhoidectomy.
