Prophylactic endoscopic vacuum therapy for stricture prevention following wide-field endoscopic submucosal dissection of superficial esophageal cancer

Tobias Blasberg; Moritz Meiborg; Johannes Richl; Marie Weber; Lukas Hiebel; Ardian Mekolli; Ali Seif Amiri Hosseini; Ahmad Amanzada; Volker Ellenrieder; Jürgen Hochberger; Edris Wedi

doi:10.1016/j.gie.2024.08.011

Prophylactic endoscopic vacuum therapy for stricture prevention following wide-field endoscopic submucosal dissection of superficial esophageal cancer

Gastrointest Endosc. 2024 Sep 10:S0016-5107(24)03437-0. doi: 10.1016/j.gie.2024.08.011. Online ahead of print.

Affiliations

¹ Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany.
² Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany.
³ Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany.
⁴ Department of Gastroenterology, Vivantes Hospital Friedrichshain Berlin, Berlin, Germany.
⁵ Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany. Electronic address: edris1@web.de.

PMID: 39265744
DOI: 10.1016/j.gie.2024.08.011

Abstract

Background and aims: Esophageal stricture (ES) is a severe adverse event following wide-field endoscopic submucosal dissection (ESD) of superficial esophageal carcinoma. This study evaluated the efficacy and safety of combining endoscopic vacuum therapy (EVT) and budesonide orodispersible tablet (BOT) in preventing post-ESD strictures.

Methods: This prospective case series included patients with superficial esophageal squamous cell carcinoma and adenocarcinoma who had wide-field ESD (≥75% circumference, resection length ≥50 mm). After ESD, EVT was applied immediately, followed by 8 weeks of BOT. The main outcome measurement was the incidence of post-ESD stricture.

Results: Eleven patients underwent ESD. Of these, 81.8% had 75-99% circumference resected, and 18.2% had a circumferential resection. EVT remained in situ for a mean of 3.5 days. No esophageal strictures were observed by the final follow-up. There were no major adverse events related to EVT or BOT.

Conclusions: The prophylactic combination of EVT and BOT is a novel and promising strategy for reducing post-ESD strictures.

Keywords: Eso-SPONGE®; Jorveza®; budesonide; endoscopic submucosal dissection; endoscopic vacuum therapy; esophageal strictures; superficial esophageal cancer.