Prevention of esophageal strictures after endoscopic submucosal dissection with the injection of botulinum toxin type A

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• 作者：Jing Wen ; MD¹ ; ² ; ^&lowast ; ; Zhongsheng Lu ; MD¹ ; ^&lowast ; ; Enqiang Linghu ; MD¹ ; Yunsheng Yang ; MD¹ ; Jing Yang ; MA¹ ; Shufang Wang ; MA¹ ; Bin Yan ; MA¹ ; Jie Song ; MA² ; Xiaodong Zhou ; MA² ; Xiangdong Wang ; MA¹ ; Ke Meng ; MD¹ ; Yan Dou ; MD¹ ; Qingsen Liu ; MD¹ ;
• 关键词：BTX-A ; botulinum toxin type A ; EORTC ; European Organisation for Research and Treatment of Cancer ; ESD ; endoscopic submucosal dissection
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：84
• 期：4
• 页码：606-613
• 全文大小：871 K

文摘

The use of endoscopic submucosal dissection (ESD) for management of widespread superficial esophageal squamous carcinoma is closely associated with esophageal stenosis. We investigated the efficacy and feasibility of endoscopic injection of botulinum toxin type A (BTX-A) for preventing esophageal strictures after ESD for superficial esophageal squamous carcinoma.

Methods

Sixty-seven patients with superficial esophageal squamous cell carcinomas with mucosal defects that exceeded one half of the circumference of the esophagus after ESD treatment were enrolled and randomly divided into 2 groups (group A, n = 33; group B, n = 34). Patients in group A (BTX-A group) were immediately injected with BTX-A after ESD, whereas patients in group B (control group) received ESD only. Endoscopy was performed when patients reported dysphagia symptoms and at 12 weeks post-ESD in patients without symptoms. Patients who experienced post-ESD esophageal strictures in both groups received bougie dilation.

Results

The number of patients who experienced esophageal strictures in group A (per protocol analysis, 6.1%, 2/33; intention to treat analysis, 11.4%, 4/35) was significantly less than that seen in group B (per protocol analysis, 32.4%, 11/34; intention to treat analysis, 37.8%, 14/37) (P < .05). Moreover, the number of bougie dilation procedures was significantly lower in group A (mean, 1.5; range, 0-2) than in group B (mean, 2.8; range, 0-5) (P < .05).

Conclusions

Endoscopic injection of BTX-A was effective in preventing post-ESD esophageal strictures and decreasing the times of bougie dilation procedures. (Clinical trial registration number: ChiCTR-TRC-12003188.)