Effect of a Combination of Local Steroid Injection With Oral Steroid Administration for the Prevention on Esophageal Stricture After Endoscopic Submucosal Dissection for Early Esophageal Neoplasm

Fudan University

Status: Completed

Conditions: Esophageal Stricture

Treatments: Drug: combination of local steroid injection（triamcinolone ）with oral steroid administration（prednisone）; Drug: oral steroid administration（prednisone）

Study type: Interventional

Funder types: Other

Identifiers

NCT03039608

xmdrct

Details and patient eligibility

About

The method of esophageal endoscopic submucosal dissection (ESD) to remove superficial esophageal neoplasms has gained widespread acceptance as an alternative to surgery recently these years especially in Asian countries. However, besides of perforation and bleeding, another complication postoperative esophageal stricture is frequently observed after the removal of large-sized esophageal neoplasms by ESD. Dysphagia caused by postoperative stricture substantially decreases the patient's quality of life, requiring further therapy. Although the exact incidence is unknown, esophageal stricture is supposed to be related to the extent of the circumference being resected. In previous study by Ono et al，it is reported that 90% of patients with lesions of circumferential extension of more than three-fourths experienced postoperative stricture after esophageal ESD. There were some reported studies exploring new ways to prevent esophageal stricture after ESD, such as oral prednisolone and local corticosteroid injection. Corticosteroids can inhibit not only collagen synthesis but also enhance collagen breakdown, thereby inhibiting stricture formation. Some studies reveled that just oral prednisolone oral is effective option for the prevention of post-ESD stricture. However, most of the reported studies were non RCTs with small sample. In the primary study, the investigators search a new method of combination of both oral and local injection to prevent esophageal stricture，as a result，stricture at 8 weeks after ESD was found in 19 of 36 patients in the no corticosteroid group but only 4 of 34 in the corticosteroid group. Unfortunately，the study was also retrospective. So, the investigators plan to undertake a prospective, randomized controlled trial to evaluate the prophylactic effects of combination of local steroid injection with oral steroid administration for esophageal stenoses complicating extensive ESD.

Enrollment: 72 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Patients who has undergone esophageal ESD
2. Histologically confirmed early squamous cell carcinoma or high grade intraepithelial neoplasia of the esophagus
3. ESD resulted in a mucosal defect involving more than two-thirds of the esophageal circumference.

Exclusion criteria

1. Severe circulatory or respiratory disease，severe renal impairment
2. Women in pregnancy and lactation
3. Patients with steroid contraindications
4. Patients refuse to join in this study

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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72 participants in 2 patient groups

combination group

Experimental group

Description:

combination of local steroid injection（triamcinolone ）with oral steroid administration（prednisone）

Treatment:

Drug: combination of local steroid injection（triamcinolone ）with oral steroid administration（prednisone）

control group

Active Comparator group

Description:

oral steroid administration（prednisone）

Treatment:

Drug: oral steroid administration（prednisone）