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Tu1244 Prevention Esophageal Stricture With Steroid After Endoscopic Submucosal Dissection in Superficial Esophageal Cancer
Abstracts
Meier curve. Metachronous recurrence rate in 3 years and 5 years were 14.1% and 42.0%, respectively. However, every new lesion were treated endoscopically. Conclusions: ELPS for hypopharynx lesions were tended to be difficult for evaluation of the horizontal margin compared to ESD for cervical esophagus lesions. However, both ELPS and ESD for superficial hypopharyngeal and cervical esophageal carcinoma could provide good outcome and prognosis.
Tu1241 Hospital Teaching Status on the Mortality and Length of Stay Amongst Patients With Esophageal Variceal Bleeding in the Us Pavan A. Patel*, Daniel D. Bodek, Nikolaos T. Pyrsopoulos, Sushil Ahlawat Rutgers - New Jersey Medical School, Woodbridge, NJ Background: Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis. There is limited data on the outcomes of patients with variceal bleeding in teaching versus nonteaching hospitals. Because variceal bleeding requires complex management, it may be hypothesized that teaching hospitals have lower mortality due to the availability of more support and advanced procedures. Objective: To assess the differences in mortality and hospital length of stay (LOS) for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the USA. Methods: The National Inpatient Sample (NIS) is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States. We collected data from the years 2008 to 2012. Cases of variceal bleeding were identified using the International Classification of Diseases, Ninth Edition, Clinical Modification codes. Differences in mortality and LOS were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and procedures performed. Results: Between 2008 and 2012, there were 7,170 cases of esophageal variceal bleeding identified. Compared with teaching hospitals, mortality was lower in non-teaching hospitals (8.2% vs. 10.7%, PZ0.001). The length of stay was shorter in nonteaching hospitals as compared to teaching hospitals (5.09 vs. 7.14 days, P<0.001). A higher proportion of non-white patients were managed in teaching hospitals. As far as procedures in nonteaching vs. teaching hospitals, esophagogastroduodenoscopy (23.3% vs. 26.4%, PZ0.009) and portosystemic shunt insertion (1.3% vs. 4.0%, P<0.001) were done more often in teaching hospitals while blood transfusions (58.6% vs. 54.4%, PZ0.001) were given more in nonteaching hospitals. Using binary logistic regression models and adjusting for baseline patient demographics, procedures and comorbid conditions including ascites, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis and hepatocellular carcinoma the mortality (odds ratio 1.265, 95% CI 1.066 to 1.502, PZ0.007) as well as LOS (odds ratio 1.532, 95% CI 1.177 to 1.886, P<0.001) in teaching hospitals remained higher. Conclusion: In patients admitted for esophageal variceal bleeding, mortality and length of stay were higher in teaching hospitals vs. nonteaching hospitals when controlling for other confounding factors. However, this study does have inherent limitations. NIS is an administrative database which predisposes to errors from coding inaccuracies as well as the inability to distinguish temporal relationships between variables including transfer of patients from non-teaching to teaching hospitals. Future prospective studies can expand on these conclusions.
Tu1242 The Novel Indicator to Determine the Anal End of Myotomy in Per-Oral Endoscopic Myotomy Shinwa Tanaka*, Takashi Toyonaga, Fumiaki Kawara, Takeshi Azuma Kobe University Hospital, Kobe, Japan Background and study aims: Per-oral endoscopic myotomy (POEM) has been already established as one of the best treatment options for achalasia due to its less invasiveness and treatment outcome. One of the technical difficulties during POEM is to ensure the appropriate myotomy length of gastric side. According to previous literature, appropriate length of gastric myotomy is 2-3 cm into the gastric cardia beyond the gastroesophageal junction (GEJ). To determine the appropriate anal end of gastric myotomy, we focused on the two penetrating vessels found in the gastric cardia (TPVs). In this study, we evaluated whether the TPVs could serve as an appropriate indicator to determine how deep we should extend the gastric myotomy. Patients and methods: The patients who were candidates for POEM were recruited for this study. When making submucosal tunnel in 5 o’clock direction into the stomach, two vessels penetrating between circular muscle and oblique muscle in the cardia can be exposed (TPVs: two penetrating vessels). The tunnel and myotomy on gastric side were extended to reach the second of TPVs. The anal end was confirmed by double-scope POEM technique after completion of creating submucosal tunnel, and the length from the GEJ to anal side end of myotomy was measured after completion of myotomy. Results: Among 37 patients who underwent myotomy in 5 o’clock position, TPVs were found in 34 patients (91.2%). Sufficient submucosal tunneling on gastric side were confirmed by double-scope POEM technique in all 34 patients. The median length of gastric myotomy was 3.0 cm (range 2 to 4 cm). Conclusion: The TPVs is a simple and reliable indicator to determine the anal end of myotomy in POEM.
Tu1243 Efficacy of Vonoprazan for Proton Pump InhibitorResistant Reflux Esophagitis Yoshimasa Hoshikawa*, Shintaro Hoshino, Noriyuki Kawami, Hiroaki Kataoka, Yuriko Hanada, Nana Takenouchi, Mariko Umezawa, Yoshio Hoshihara, Katsuhiko Iwakiri Gastroenterology, Nippon Medical School, Tokyo, Japan Background: Reflux esophagitis (RE) is caused by excessive esophageal acid exposure. Although proton pump inhibitors (PPIs) are used as the first-line treatment for RE, PPIresistant RE, which does not respond to standard-dose PPI therapy for 8 weeks or more, also occurs. In February 2015, vonoprazan (VPZ), which is a novel potassiumcompetitive acid blocker (P-CAB) that exerts more potent and sustained acid-inhibitory effects than PPIs, became commercially available. The aim of this study is to investigate the efficacies of VPZ therapy at 20 mg for 4 weeks in patients with PPIresistant RE and VPZ maintenance therapy at 10 mg for 8 weeks in patients who have been successfully treated. Methods: Subjects comprised 26 patients with PPI-resistant RE in whom esophageal mucosal breaks persisted despite the oral administration of standard-dose PPIs for 8 weeks or more (13 males, 13 females, mean age: 71.2 years, LA classification grade A: 3 patients, B: 7, C: 13, and D: 3). All patients were negative for Helicobacter pylori infection (after eradication: 3 patients). Hiatal hernias measuring 2 cm or larger were detected in 23 patients (3 cm or larger: 18 patients). After confirming PPI-resistant RE by endoscopy, 20 mg VPZ was administered. Endoscopy was performed 4 weeks after the initiation of VPZ. Symptoms were evaluated using the frequency scale for the symptoms of GERD (FSSG) immediately before dosing every day for 1 week, and then on days 14 and 28 after the initiation of VPZ. In patients who were shifted to maintenance therapy, maintenance therapy with 10 mg VPZ was performed, endoscopy was conducted after 8 weeks, and morning fasting gastrin levels was measured at the completion of maintenance therapy with 10 mg VPZ for 8 weeks. Results: In 23 (88.5%) out of 26 patients, esophageal mucosal breaks were successfully treated by 20 mg VPZ. The median FSSG score was significantly lower on days 1-7, 14, and 28 after the initiation of VPZ than before its administration. Maintenance therapy with 10 mg VPZ prevented the relapse of esophageal mucosal breaks in 18 (78.3%) out of 23 patients. The median gastrin level before breakfast 8 weeks after the start of maintenance therapy was 1,158 pg/mL. Conclusion: The efficacies of 20 mg VPZ for PPI-resistant RE patients and 10 mg VPZ after endoscopic healing were confirmed.
Tu1244 Prevention Esophageal Stricture With Steroid After Endoscopic Submucosal Dissection in Superficial Esophageal Cancer Gyu Young Pih*, Do Hoon Kim, Hee Kyong Na, Kee Wook Jung, Jeong Hoon Lee, Ji Yong Ahn, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung Department of Gastroenterology, Asan Medical Center, Seoul, Korea (the Republic of) Patient Demographics, Hospital Characteristics and Outcomes
AB598 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
Background and Aims: Esophageal stricture after endoscopic submucosal dissection (ESD) is a significant complication impairing patient’s quality of life. Recently, prophylactic steroid administration is being reported as a beneficial method to overcome esophageal stricture. We investigated the efficacy of steroid to determine its feasibility and effectiveness in preventing the post-ESD stricture. Patients and Methods: Subjects who underwent ESD with mucosal defect involving over three-
www.giejournal.org
Abstracts
fourth of esophageal circumference and extending more than 3cm in longitudinal diameter for superficial esophageal cancer between January 2011 and August 2016 were eligible. The medical records were retrospectively reviewed and clinical characteristics were investigated. Stricture is defined as an inability to pass an endoscope. Results: A total of 45 subjects underwent ESD for 45 lesions. Twenty-five patients administered 30mg of oral steroid 3 days after ESD and gradually tapered through 8 weeks (daily 30, 30, 25, 25, 20, 15, 10, 5mg for 7 days each). Six patients underwent single session of intralesional steroid injection immediately after ESD with triamcinolone 40mg-160mg. Stricture was found in 11 of 45 patients (24.4 %). Stricture presented in 12% (3/25) in oral steroid group and 16.7% (1/6) in intralesional steroid injection group. ESD alone group showed 50.0% (7/14) of stricture rate. Prophylactic oral steroid group showed significantly lower stricture rate compared to ESD alone group (P<0.017). Among three patients with stricture in oral steroid group, two patients received total 2 times of endoscopic balloon dilatation (EBD) and one patient underwent stent insertion. In intralesional steroid group, one patient underwent 4 times of EBD. Seven patients with stricture in ESD alone group underwent average 1.6 times EBD. Conclusion: Prophylactic oral steroid administration is feasible and effective methods for preventing post-ESD stricture in SEC.
different parameters described on the literature, such as the patient’s pain and laceration size. However, few studies have adopted the evaluation of loss of the radiological waist as a parameter to guide the procedure. Objective: To describe the hydrostatic dilation of the cardia technique guided by the loss of the radiological waist, its results and safety. Technique and Methods: This is a prospective study of consecutive cases conducted between December 2015 and September 2016. The patients underwent the procedure under intravenous sedation, in an outpatient setting and assisted by fluoroscopy. A 30 mm Rigiflex balloon was used for patients without previous endoscopic dilation and a 35 mm balloon in patients already submitted to the procedure. Initially, endoscopy was performed for the identification and measurement of the esophagogastric junction, where the balloon was positioned using a metallic guidewire. The balloon was inflated with 10 mL of contrast followed by insufflation with saline until the formation and subsequent loss of the radiological waist. In cases where the radiological waist was not formed, the balloon was inflated to the maximum pressure (1.4 atm). Dilation response was assessed by means of the predilation and 30 days post-dilation Eckardt score. A score 3 post-dilation was considered satisfactory; partial response corresponded to a decrease in the score, but with final Eckardt > 3. Patients also performed an endoscopy between 1 and 10 months after of the procedure. Results: 59 patients underwent cardia dilation, 32 were female, with a mean age of 59.8 years old, 9 had Chagas disease as the etiology of achalasia, and in 50 the cause was idiopathic. 19 had undergone surgical cardiomyotomy. The diameter of the balloon used was 30 mm in 27 patients and 35 mm in 33 patients. The mean pre-dilation Eckardt score was 5.66. There was radiological waist formation in 49 patients, with loss of the waist with a balloon pressure with a mean of 1.1 atm. After 30 days, patients mean Eckardt score was 2.66 (p < 0.01), and there was satisfactory clinical response in 43 patients (72.8%) and partial in 8 patients (13.6%), with therapeutic failure in 8 patients (13.6%). Post-dilation endoscopy showed 11 patients (18.6%) with erosive esophagitis (8 grade A of Los Angeles, 1 grade B and 2 grade C). There was one case of esophageal perforation, treated with endoscopic closure with clips, antibiotics and nasoenteric tube. Conclusion: The cardia hydrostatic dilation with loss of the radiological waist as a parameter is a safe, objective and effective technique in the treatment of dysphagia in patients with achalasia.
Tu1246 Efficacy of Oral Mixture of Hydrocortisone Sodium Succinate and Aluminum Phosphate Gel for the Prevention of Stricture After ≥2/3 Circumferential Endoscopic Submucosal Dissection (ESD) for Esophageal Cancer - A Single Center Pilot Study From China YongHui Huang*, Hong Chang, X. I. U. E. YAN, Wei Yao, Ke Li, YaoPeng Zhang Peking University Third Hospital, Beijing, —选择—, China
Tu1245 Hydrostatic Dilation of the Cardia for Achalasia: Technique and Results Using the Loss of the Radiological Waist As a Procedure Guidance Parameter. A Prospective Case Study Fabio R. Marinho, Eduardo T. Moura*, Lara M. Coutinho, Aureo Delgado, Leonardo Zorron, Martin Coronel, Diogo T. de Moura, Spencer Cheng, Rubens A. Sallum, Paulo Sakai, Eduardo G. de Moura HCFMUSP, Sao Paulo, Brazil Introduction: Pneumatic dilation of the cardia is widely used in the treatment for dysphagia in patients with achalasia, beingperformed under direct endoscope vision or assisted by fluoroscopy. The specific time for dilation interruption follows
www.giejournal.org
Background and Aims: ESD has been performed on many patients with early stage esophageal cancer. However, postoperative stricture after2/3circumferential ESD is the most important issues for quality of life in patients which is drastically decreased and repeat, periodic endoscopic balloon dilatation(EBD) is usually required over long periods. We explore an innovative strategy with oral mixture of hydrocortisone sodium succinate and Aluminum phosphate gel for prevention of the stricture and evaluate the efficacy of this mixture in single center of Beijing,China. Patients and Methods: In total,13 patients who underwent more than 2/3 circular or complete circular ESD for esophageal superficial squamous cell carcinoma were included in this study. They all received preventative strategy for stricture and were divided into three groups chronologically. Four patients received systemic steroid treatment (STgroup), 3 patients received endoscopic intralesional steroid (triamcinolone acetonide 80mg) injection accompanied with systemic steroid treatment(IT+ST group),6 patients received oral mixture of hydrocortisone sodium succinate and aluminum phosphate gel(OHA group). We compared three groups in terms of stricture rate and total number of endoscopic balloon dilatation(EBD) sessions. ST groups started with 30mg/day prednisolone on the second day post-ESD,finally discontinuing systemic steroid administration 8 weeks later. IT+ST group received 30mg/day prednisolone on the second day post-ESD after injection. OHA group started with mixture of hydrocortisone sodium succinate 50mg and aluminum phosphate gel 20g, qid for 2weeks and continued with a gradually tapering OHA dose. Esophagogastroduodenoscopy was performed on demand whenever patients complained of dysphagia. If the patient had no complaint of dysphagia, EGD was performed 8 weeks after ESD to evaluate any possible stricture. A stricture was defined as a difficulty in swallowing solids or an inability to pass an EGD (9.2mm diameter endoscope). Results: There were two complete and two 75% circular ESD in ST group, one complete and two 75% circular ESD cases in IT+ST group, and one complete and five 75% circular ESD cases in OHA group. 12 cases were resected en bloc with tumor free lateral and basal margins. No complications were seen after this procedure. The stricture rates of ST, IT+ST, OHA group after ESD were 100%,33%,0%, respectively. One patient with stricture after ESD had lateral recurrence at the margin of ulcer. One EBD was performed in three patients in ST group and one patient in IT+ST group with stricture. One patient in ST group underwent operation in response to patient demand. Conclusions: Short period, oral mixture of hydrocortisone sodium succinate and aluminum phosphate gel showed promising results for the prevention of stricture after ESD for early stage esophageal cancers.
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB599
Meier curve. Metachronous recurrence rate in 3 years and 5 years were 14.1% and 42.0%, respectively. However, every new lesion were treated endoscopically. Conclusions: ELPS for hypopharynx lesions were tended to be difficult for evaluation of the horizontal margin compared to ESD for cervical esophagus lesions. However, both ELPS and ESD for superficial hypopharyngeal and cervical esophageal carcinoma could provide good outcome and prognosis.
Tu1241 Hospital Teaching Status on the Mortality and Length of Stay Amongst Patients With Esophageal Variceal Bleeding in the Us Pavan A. Patel*, Daniel D. Bodek, Nikolaos T. Pyrsopoulos, Sushil Ahlawat Rutgers - New Jersey Medical School, Woodbridge, NJ Background: Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis. There is limited data on the outcomes of patients with variceal bleeding in teaching versus nonteaching hospitals. Because variceal bleeding requires complex management, it may be hypothesized that teaching hospitals have lower mortality due to the availability of more support and advanced procedures. Objective: To assess the differences in mortality and hospital length of stay (LOS) for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the USA. Methods: The National Inpatient Sample (NIS) is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States. We collected data from the years 2008 to 2012. Cases of variceal bleeding were identified using the International Classification of Diseases, Ninth Edition, Clinical Modification codes. Differences in mortality and LOS were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and procedures performed. Results: Between 2008 and 2012, there were 7,170 cases of esophageal variceal bleeding identified. Compared with teaching hospitals, mortality was lower in non-teaching hospitals (8.2% vs. 10.7%, PZ0.001). The length of stay was shorter in nonteaching hospitals as compared to teaching hospitals (5.09 vs. 7.14 days, P<0.001). A higher proportion of non-white patients were managed in teaching hospitals. As far as procedures in nonteaching vs. teaching hospitals, esophagogastroduodenoscopy (23.3% vs. 26.4%, PZ0.009) and portosystemic shunt insertion (1.3% vs. 4.0%, P<0.001) were done more often in teaching hospitals while blood transfusions (58.6% vs. 54.4%, PZ0.001) were given more in nonteaching hospitals. Using binary logistic regression models and adjusting for baseline patient demographics, procedures and comorbid conditions including ascites, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis and hepatocellular carcinoma the mortality (odds ratio 1.265, 95% CI 1.066 to 1.502, PZ0.007) as well as LOS (odds ratio 1.532, 95% CI 1.177 to 1.886, P<0.001) in teaching hospitals remained higher. Conclusion: In patients admitted for esophageal variceal bleeding, mortality and length of stay were higher in teaching hospitals vs. nonteaching hospitals when controlling for other confounding factors. However, this study does have inherent limitations. NIS is an administrative database which predisposes to errors from coding inaccuracies as well as the inability to distinguish temporal relationships between variables including transfer of patients from non-teaching to teaching hospitals. Future prospective studies can expand on these conclusions.
Tu1242 The Novel Indicator to Determine the Anal End of Myotomy in Per-Oral Endoscopic Myotomy Shinwa Tanaka*, Takashi Toyonaga, Fumiaki Kawara, Takeshi Azuma Kobe University Hospital, Kobe, Japan Background and study aims: Per-oral endoscopic myotomy (POEM) has been already established as one of the best treatment options for achalasia due to its less invasiveness and treatment outcome. One of the technical difficulties during POEM is to ensure the appropriate myotomy length of gastric side. According to previous literature, appropriate length of gastric myotomy is 2-3 cm into the gastric cardia beyond the gastroesophageal junction (GEJ). To determine the appropriate anal end of gastric myotomy, we focused on the two penetrating vessels found in the gastric cardia (TPVs). In this study, we evaluated whether the TPVs could serve as an appropriate indicator to determine how deep we should extend the gastric myotomy. Patients and methods: The patients who were candidates for POEM were recruited for this study. When making submucosal tunnel in 5 o’clock direction into the stomach, two vessels penetrating between circular muscle and oblique muscle in the cardia can be exposed (TPVs: two penetrating vessels). The tunnel and myotomy on gastric side were extended to reach the second of TPVs. The anal end was confirmed by double-scope POEM technique after completion of creating submucosal tunnel, and the length from the GEJ to anal side end of myotomy was measured after completion of myotomy. Results: Among 37 patients who underwent myotomy in 5 o’clock position, TPVs were found in 34 patients (91.2%). Sufficient submucosal tunneling on gastric side were confirmed by double-scope POEM technique in all 34 patients. The median length of gastric myotomy was 3.0 cm (range 2 to 4 cm). Conclusion: The TPVs is a simple and reliable indicator to determine the anal end of myotomy in POEM.
Tu1243 Efficacy of Vonoprazan for Proton Pump InhibitorResistant Reflux Esophagitis Yoshimasa Hoshikawa*, Shintaro Hoshino, Noriyuki Kawami, Hiroaki Kataoka, Yuriko Hanada, Nana Takenouchi, Mariko Umezawa, Yoshio Hoshihara, Katsuhiko Iwakiri Gastroenterology, Nippon Medical School, Tokyo, Japan Background: Reflux esophagitis (RE) is caused by excessive esophageal acid exposure. Although proton pump inhibitors (PPIs) are used as the first-line treatment for RE, PPIresistant RE, which does not respond to standard-dose PPI therapy for 8 weeks or more, also occurs. In February 2015, vonoprazan (VPZ), which is a novel potassiumcompetitive acid blocker (P-CAB) that exerts more potent and sustained acid-inhibitory effects than PPIs, became commercially available. The aim of this study is to investigate the efficacies of VPZ therapy at 20 mg for 4 weeks in patients with PPIresistant RE and VPZ maintenance therapy at 10 mg for 8 weeks in patients who have been successfully treated. Methods: Subjects comprised 26 patients with PPI-resistant RE in whom esophageal mucosal breaks persisted despite the oral administration of standard-dose PPIs for 8 weeks or more (13 males, 13 females, mean age: 71.2 years, LA classification grade A: 3 patients, B: 7, C: 13, and D: 3). All patients were negative for Helicobacter pylori infection (after eradication: 3 patients). Hiatal hernias measuring 2 cm or larger were detected in 23 patients (3 cm or larger: 18 patients). After confirming PPI-resistant RE by endoscopy, 20 mg VPZ was administered. Endoscopy was performed 4 weeks after the initiation of VPZ. Symptoms were evaluated using the frequency scale for the symptoms of GERD (FSSG) immediately before dosing every day for 1 week, and then on days 14 and 28 after the initiation of VPZ. In patients who were shifted to maintenance therapy, maintenance therapy with 10 mg VPZ was performed, endoscopy was conducted after 8 weeks, and morning fasting gastrin levels was measured at the completion of maintenance therapy with 10 mg VPZ for 8 weeks. Results: In 23 (88.5%) out of 26 patients, esophageal mucosal breaks were successfully treated by 20 mg VPZ. The median FSSG score was significantly lower on days 1-7, 14, and 28 after the initiation of VPZ than before its administration. Maintenance therapy with 10 mg VPZ prevented the relapse of esophageal mucosal breaks in 18 (78.3%) out of 23 patients. The median gastrin level before breakfast 8 weeks after the start of maintenance therapy was 1,158 pg/mL. Conclusion: The efficacies of 20 mg VPZ for PPI-resistant RE patients and 10 mg VPZ after endoscopic healing were confirmed.
Tu1244 Prevention Esophageal Stricture With Steroid After Endoscopic Submucosal Dissection in Superficial Esophageal Cancer Gyu Young Pih*, Do Hoon Kim, Hee Kyong Na, Kee Wook Jung, Jeong Hoon Lee, Ji Yong Ahn, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung Department of Gastroenterology, Asan Medical Center, Seoul, Korea (the Republic of) Patient Demographics, Hospital Characteristics and Outcomes
AB598 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
Background and Aims: Esophageal stricture after endoscopic submucosal dissection (ESD) is a significant complication impairing patient’s quality of life. Recently, prophylactic steroid administration is being reported as a beneficial method to overcome esophageal stricture. We investigated the efficacy of steroid to determine its feasibility and effectiveness in preventing the post-ESD stricture. Patients and Methods: Subjects who underwent ESD with mucosal defect involving over three-
www.giejournal.org
Abstracts
fourth of esophageal circumference and extending more than 3cm in longitudinal diameter for superficial esophageal cancer between January 2011 and August 2016 were eligible. The medical records were retrospectively reviewed and clinical characteristics were investigated. Stricture is defined as an inability to pass an endoscope. Results: A total of 45 subjects underwent ESD for 45 lesions. Twenty-five patients administered 30mg of oral steroid 3 days after ESD and gradually tapered through 8 weeks (daily 30, 30, 25, 25, 20, 15, 10, 5mg for 7 days each). Six patients underwent single session of intralesional steroid injection immediately after ESD with triamcinolone 40mg-160mg. Stricture was found in 11 of 45 patients (24.4 %). Stricture presented in 12% (3/25) in oral steroid group and 16.7% (1/6) in intralesional steroid injection group. ESD alone group showed 50.0% (7/14) of stricture rate. Prophylactic oral steroid group showed significantly lower stricture rate compared to ESD alone group (P<0.017). Among three patients with stricture in oral steroid group, two patients received total 2 times of endoscopic balloon dilatation (EBD) and one patient underwent stent insertion. In intralesional steroid group, one patient underwent 4 times of EBD. Seven patients with stricture in ESD alone group underwent average 1.6 times EBD. Conclusion: Prophylactic oral steroid administration is feasible and effective methods for preventing post-ESD stricture in SEC.
different parameters described on the literature, such as the patient’s pain and laceration size. However, few studies have adopted the evaluation of loss of the radiological waist as a parameter to guide the procedure. Objective: To describe the hydrostatic dilation of the cardia technique guided by the loss of the radiological waist, its results and safety. Technique and Methods: This is a prospective study of consecutive cases conducted between December 2015 and September 2016. The patients underwent the procedure under intravenous sedation, in an outpatient setting and assisted by fluoroscopy. A 30 mm Rigiflex balloon was used for patients without previous endoscopic dilation and a 35 mm balloon in patients already submitted to the procedure. Initially, endoscopy was performed for the identification and measurement of the esophagogastric junction, where the balloon was positioned using a metallic guidewire. The balloon was inflated with 10 mL of contrast followed by insufflation with saline until the formation and subsequent loss of the radiological waist. In cases where the radiological waist was not formed, the balloon was inflated to the maximum pressure (1.4 atm). Dilation response was assessed by means of the predilation and 30 days post-dilation Eckardt score. A score 3 post-dilation was considered satisfactory; partial response corresponded to a decrease in the score, but with final Eckardt > 3. Patients also performed an endoscopy between 1 and 10 months after of the procedure. Results: 59 patients underwent cardia dilation, 32 were female, with a mean age of 59.8 years old, 9 had Chagas disease as the etiology of achalasia, and in 50 the cause was idiopathic. 19 had undergone surgical cardiomyotomy. The diameter of the balloon used was 30 mm in 27 patients and 35 mm in 33 patients. The mean pre-dilation Eckardt score was 5.66. There was radiological waist formation in 49 patients, with loss of the waist with a balloon pressure with a mean of 1.1 atm. After 30 days, patients mean Eckardt score was 2.66 (p < 0.01), and there was satisfactory clinical response in 43 patients (72.8%) and partial in 8 patients (13.6%), with therapeutic failure in 8 patients (13.6%). Post-dilation endoscopy showed 11 patients (18.6%) with erosive esophagitis (8 grade A of Los Angeles, 1 grade B and 2 grade C). There was one case of esophageal perforation, treated with endoscopic closure with clips, antibiotics and nasoenteric tube. Conclusion: The cardia hydrostatic dilation with loss of the radiological waist as a parameter is a safe, objective and effective technique in the treatment of dysphagia in patients with achalasia.
Tu1246 Efficacy of Oral Mixture of Hydrocortisone Sodium Succinate and Aluminum Phosphate Gel for the Prevention of Stricture After ≥2/3 Circumferential Endoscopic Submucosal Dissection (ESD) for Esophageal Cancer - A Single Center Pilot Study From China YongHui Huang*, Hong Chang, X. I. U. E. YAN, Wei Yao, Ke Li, YaoPeng Zhang Peking University Third Hospital, Beijing, —选择—, China
Tu1245 Hydrostatic Dilation of the Cardia for Achalasia: Technique and Results Using the Loss of the Radiological Waist As a Procedure Guidance Parameter. A Prospective Case Study Fabio R. Marinho, Eduardo T. Moura*, Lara M. Coutinho, Aureo Delgado, Leonardo Zorron, Martin Coronel, Diogo T. de Moura, Spencer Cheng, Rubens A. Sallum, Paulo Sakai, Eduardo G. de Moura HCFMUSP, Sao Paulo, Brazil Introduction: Pneumatic dilation of the cardia is widely used in the treatment for dysphagia in patients with achalasia, beingperformed under direct endoscope vision or assisted by fluoroscopy. The specific time for dilation interruption follows
www.giejournal.org
Background and Aims: ESD has been performed on many patients with early stage esophageal cancer. However, postoperative stricture after2/3circumferential ESD is the most important issues for quality of life in patients which is drastically decreased and repeat, periodic endoscopic balloon dilatation(EBD) is usually required over long periods. We explore an innovative strategy with oral mixture of hydrocortisone sodium succinate and Aluminum phosphate gel for prevention of the stricture and evaluate the efficacy of this mixture in single center of Beijing,China. Patients and Methods: In total,13 patients who underwent more than 2/3 circular or complete circular ESD for esophageal superficial squamous cell carcinoma were included in this study. They all received preventative strategy for stricture and were divided into three groups chronologically. Four patients received systemic steroid treatment (STgroup), 3 patients received endoscopic intralesional steroid (triamcinolone acetonide 80mg) injection accompanied with systemic steroid treatment(IT+ST group),6 patients received oral mixture of hydrocortisone sodium succinate and aluminum phosphate gel(OHA group). We compared three groups in terms of stricture rate and total number of endoscopic balloon dilatation(EBD) sessions. ST groups started with 30mg/day prednisolone on the second day post-ESD,finally discontinuing systemic steroid administration 8 weeks later. IT+ST group received 30mg/day prednisolone on the second day post-ESD after injection. OHA group started with mixture of hydrocortisone sodium succinate 50mg and aluminum phosphate gel 20g, qid for 2weeks and continued with a gradually tapering OHA dose. Esophagogastroduodenoscopy was performed on demand whenever patients complained of dysphagia. If the patient had no complaint of dysphagia, EGD was performed 8 weeks after ESD to evaluate any possible stricture. A stricture was defined as a difficulty in swallowing solids or an inability to pass an EGD (9.2mm diameter endoscope). Results: There were two complete and two 75% circular ESD in ST group, one complete and two 75% circular ESD cases in IT+ST group, and one complete and five 75% circular ESD cases in OHA group. 12 cases were resected en bloc with tumor free lateral and basal margins. No complications were seen after this procedure. The stricture rates of ST, IT+ST, OHA group after ESD were 100%,33%,0%, respectively. One patient with stricture after ESD had lateral recurrence at the margin of ulcer. One EBD was performed in three patients in ST group and one patient in IT+ST group with stricture. One patient in ST group underwent operation in response to patient demand. Conclusions: Short period, oral mixture of hydrocortisone sodium succinate and aluminum phosphate gel showed promising results for the prevention of stricture after ESD for early stage esophageal cancers.
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB599