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

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

Gastrointest Endosc. 2016 Mar 28;

Authors: Wen J, Lu Z, Linghu E, Yang Y, Yang J, Wang S, Yan B, Song J, Zhou X, Wang X, Meng K, Dou Y, Liu Q

Abstract
BACKGROUND & AIMS: Use of endoscopic submucosal dissection (ESD) for management of widespread superficial esophageal squamous carcinoma is closely associated with esophageal stenosis. We aimed to investigate 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 superficial esophageal squamous cell carcinomas patients with a 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 of 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 experienced post-ESD esophageal stricture in both groups received bougie dilation.
RESULTS: The number of patients who experienced esophageal stricture in group A (PP analysis, 6.1%, 2/33; ITT analysis, 11.4%, 4/35) was significantly less than that seen in group B (PP analysis, 32.4%, 11/34; ITT analysis, 37.8%, 14/37) (P < 0.05). 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<0.05).
CONCLUSIONS: Endoscopic injection of BTX-A was effective in preventing post-ESD esophageal stricture and decreasing the times of bougie dilation procedures.

PMID: 27032884 [PubMed - as supplied by publisher]

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