短程口服糖皮质激素预防大面积食管内镜黏膜下剥离术后狭窄的疗效观察

Efficacy and safety of short-term oral glucocorticoid for prevention of esophageal stenosis after extensive endoscopic submucosal dissection

摘要:

目的 评估短程口服糖皮质激素，预防大面积食管内镜黏膜下剥离术（ESD）后狭窄的有效性和安全性。方法 纳入2020年1月－2023年1月该院消化内科因食管早癌行ESD，且手术剥离食管面积 ≥ 3/4环周的患者44例，所有患者在ESD后均接受糖皮质激素治疗，根据糖皮质激素使用疗程分为：3周疗法组和8周疗法组，对比两组患者术后狭窄率、难治性狭窄率、术后内镜球囊扩张术（EBD）例数及频次和激素相关不良事件发生率。结果 3周疗法组和8周疗法组ESD后食管狭窄率分别为33.3%（5/15）和48.3%（14/29），差异无统计学意义（χ² = 0.90，P = 0.343）；术后难治性狭窄率分别为6.7%（1/15）和10.3%（3/29），差异无统计学意义（P > 0.05）；ESD后使用EBD率分别为20.0%（3/15）和41.4%（12/29），差异无统计学意义（χ² = 2.01，P = 0.156）；接受球囊扩张次数分别为0（0，0）和0（0，1）次，差异无统计学意义（Z = 1.44，P = 0.149）。8周疗法组糖皮质激素相关不良反应发生率为31.0%（9/29），3周疗法组中无糖皮质激素不良事件发生，差异有统计学意义（P = 0.043）。结论 3周疗法和8周疗法在降低大面积食管ESD后食管狭窄的发生率、球囊扩张率，以及减少球囊扩张频次方面，效果相当，3周疗法组的糖皮质激素不良事件发生率明显较8周疗法组低，短程糖皮质激素预防食管ESD后狭窄，安全性较高。

Abstract:

Objective To evaluate the efficacy and safety of short-term oral glucocorticoids for prevention of esophageal stenosis after extensive endoscopic submucosal dissection (ESD).Methods From January 2020 to January 2023, 44 patients who underwent ESD for early esophageal cancer and the mucosal dissection area ≥ 3/4 of the esophageal circumference were included. All patients received glucocorticoid therapy after ESD, and were divided into 3-week treatment group and 8-week treatment group according to the treatment course of glucocorticoid. The incidence of stenosis, the rate of refractory stenosis, the number of people and frequency of cases of postoperative endoscopic balloon dilatation (EBD), and the incidence of hormone-related adverse events in the two groups were compared.Results The stenosis rates of the 3-week treatment group and the 8-week treatment group were 33.3% (5/15) and 48.3% (14/29), respectively, with no statistical significance (χ² = 0.90, P = 0.343). The rates of refractory stenosis after ESD were 6.7% (1/15) and 10.3% (3/29), respectively, with no statistical significance (P > 0.05). The rate of EBD after ESD in the 3-week treatment group and the 8-week treatment group was 20.0% (3/15) and 41.4% (12/29), respectively, with no statistical significance (χ² = 2.01, P = 0.156). The median (range) of receiving EBD times in the two groups were 0 (0, 0) and 0 (0, 1), respectively, with no statistical significance (Z = 1.44, P = 0.149). The incidence of glucocorticoid-related adverse events was 31.0% (9/29) in the 8-week treatment group, and no glucocorticoid-related adverse events occurred in the 3-week treatment group, with statistical significance (P = 0.043).Conclusion 3-week treatment and 8-week treatment are equally effective in reducing the incidence, EBD rate and frequency of esophageal stenosis after extensive ESD. The incidence of glucocorticoid adverse events in the 3-week treatment group is significantly lower than that in the 8-week treatment group, and short-term glucocorticoid treatment has a good safety in preventing stenosis after esophageal ESD.