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Abstract：
OBJECTIVE: There is a lack of effective and safe methods for preventing esophageal stricture after large endoscopic submucosal dissection (ESD) in patients with superficial esophageal cancer. We aimed to compare the effectiveness of oral prednisolone alone versus a combination of oral prednisolone and nasogastric tube in preventing esophageal stricture following extensive ESD.
METHODS: We retrospectively gathered clinical data from a single center on patients with early esophageal cancer who underwent ESD. Patients were categorized into 2 groups: the steroid group (receiving only oral prednisolone) and the steroid+nasogastric tube retention (NGT) group. We analyzed the incidence of esophageal stricture and identified risk factors for its development.
RESULTS: The study included 79 patients, with 30 in the steroid group and 49 in the steroid+NGT group. The incidence of stricture was significantly higher in the steroid group (9/30, 30.0%) compared to the steroid+NGT group (3/49, 6.1%) (P = .004). Notably, we observed a significant difference in the stricture rates between the 2 groups, particularly in patients with a complete circumferential defect (100% and 16.7%) (P = .015). Multivariate logistic regression analysis revealed that a full circumferential defect of the esophageal mucosa (OR 12.501; 95% CI 1.907, 81.047; P = .008), invasion depth beyond the lamina propria (OR 5.635; 95% CI 1.039, 30.559; P = .045), and the absence of NGT retention (OR 12.896; 95% CI 2.099, 79.219; P = .006) were independent risk factors predicting the development of a stricture.
CONCLUSIONS: The combination of steroids with NGT retention is more effective than using oral steroids alone in preventing esophageal stricture after extensive ESD.
METHODS: We retrospectively gathered clinical data from a single center on patients with early esophageal cancer who underwent ESD. Patients were categorized into 2 groups: the steroid group (receiving only oral prednisolone) and the steroid+nasogastric tube retention (NGT) group. We analyzed the incidence of esophageal stricture and identified risk factors for its development.
RESULTS: The study included 79 patients, with 30 in the steroid group and 49 in the steroid+NGT group. The incidence of stricture was significantly higher in the steroid group (9/30, 30.0%) compared to the steroid+NGT group (3/49, 6.1%) (P = .004). Notably, we observed a significant difference in the stricture rates between the 2 groups, particularly in patients with a complete circumferential defect (100% and 16.7%) (P = .015). Multivariate logistic regression analysis revealed that a full circumferential defect of the esophageal mucosa (OR 12.501; 95% CI 1.907, 81.047; P = .008), invasion depth beyond the lamina propria (OR 5.635; 95% CI 1.039, 30.559; P = .045), and the absence of NGT retention (OR 12.896; 95% CI 2.099, 79.219; P = .006) were independent risk factors predicting the development of a stricture.
CONCLUSIONS: The combination of steroids with NGT retention is more effective than using oral steroids alone in preventing esophageal stricture after extensive ESD.
摘要：
目的：目前还缺乏有效、安全的方法来预防浅表性食管癌患者内镜下黏膜下剥离术(ESD)后食管狭窄。我们旨在比较单独口服泼尼松龙与口服泼尼松龙和鼻胃管联合预防广泛ESD后食管狭窄的有效性。
方法：我们回顾性收集了一个单中心的早期食管癌患者接受ESD治疗的临床数据。患者分为2组：类固醇组（仅接受口服泼尼松龙）和类固醇鼻胃管留置（NGT）组。我们分析了食管狭窄的发生率，并确定了其发展的危险因素。
结果：该研究包括79名患者，类固醇组30例，类固醇+NGT组49例。类固醇组（9/30，30.0％）的狭窄发生率明显高于类固醇NGT组（3/49，6.1％）（P=.004）。值得注意的是,我们观察到两组之间的狭窄率存在显着差异，特别是在具有完全环状缺损的患者中（100％和16.7％）（P=0.015）。多因素logistic回归分析显示食管黏膜全环缺损(OR12.501;95%CI1.907,81.047;P=.008),固有层以外的侵入深度(OR5.635;95%CI1.039,30.559;P=.045),无NGT保留(OR12.896;95%CI2.099,79.219;P=.006)是预测狭窄发展的独立危险因素。
结论：类固醇联合NGT滞留比单独使用口服类固醇更有效地预防广泛ESD后的食管狭窄。
方法：我们回顾性收集了一个单中心的早期食管癌患者接受ESD治疗的临床数据。患者分为2组：类固醇组（仅接受口服泼尼松龙）和类固醇鼻胃管留置（NGT）组。我们分析了食管狭窄的发生率，并确定了其发展的危险因素。
结果：该研究包括79名患者，类固醇组30例，类固醇+NGT组49例。类固醇组（9/30，30.0％）的狭窄发生率明显高于类固醇NGT组（3/49，6.1％）（P=.004）。值得注意的是,我们观察到两组之间的狭窄率存在显着差异，特别是在具有完全环状缺损的患者中（100％和16.7％）（P=0.015）。多因素logistic回归分析显示食管黏膜全环缺损(OR12.501;95%CI1.907,81.047;P=.008),固有层以外的侵入深度(OR5.635;95%CI1.039,30.559;P=.045),无NGT保留(OR12.896;95%CI2.099,79.219;P=.006)是预测狭窄发展的独立危险因素。
结论：类固醇联合NGT滞留比单独使用口服类固醇更有效地预防广泛ESD后的食管狭窄。
