Local Triamcinolone Injection Combined With Fibrin Glue Spray in Preventing Esophageal Stricture After Big-range Endoscopic Submucosal Dissection for Esophageal Early Cancer

Endoscopic submucosal dissection (ESD) is the main treatment for esophageal early cancer. But post-ESD stricture has a serious impact on quality of life.When the lesion range reaches up to 3/4 circumferential mucosal defect or the longitudinal length over 5cm, the esophageal stricture rate will be over 70% or more, and when the whole circumferential mucosal defect, the rate is up to 100%. Local triamcinolone (TA) injection has positive effect on post-ESD stricture.But there are no uniform standards and results of the TA usage. Investigators also found a disadvantage that TA injection was hard to be absorbed completely in the submucosal layer and spilled over easily, which may decrease the preventive effect. The investigators tried to make a better protocol that could adjust the time and frequency of triamcinolone injection to improve the medicine duration of stay and decrease the stricture rate. So, the aim of this study was to investigate the efficacy and safety of TA injection in a new way for preventing post-ESD stricture. This is a single-center prospective intervention study, and single-arm trial too, which is carried out at Sun Yat-Sen University Cancer Center in Guangzhou, China. Participants recruited into the study must meet the standards as follows: (a). be staged as cT1aN0M0 or cT1bN0M0 before surgery via magnifying endoscopy, endosonography, CT, or PET/CT; (b). refuse conventional surgery and CRT and get ESD as first-line treatment; (c). mucosal defect measured by a circular protractor and reached more than three-quarters of the circumference of the esophageal lumen including whole circumference after ESD surgery; (d). sign the consent before ESD;(e). meet the minimum follow-up period of three months. In the protocol, TA injection combined with fibrin glue was used twice, immediately (D0) and 7days(D7) after ESD to increase TA's residual time and effect in the study group. Meanwhile, the stickiness of fibrin glue can protect the wound for preventing perforation or bleeding. The dosage of TA and fibrin glue were 100mg and 5-10ml in every session separately. The first target of this study was the frequency of stricture lasting at least three months follow-ups. And the second targets were the number of endoscopic bougie dilation or balloon dilation (EBD), stricture classification, stooler score and complications in the study group. The expectational results are as follows: the first is that TA injection combined with firin glue spray can greatly decrease the esophgeal stricture rate after long-range ESD; the second is that TA injection combined with firin glue spray can also decrease the frequency of endoscopic bougie dilation or balloon dilation (EBD), complications, and the degree of stricture classification and stooler score compared with historical data. This study will show that TA injection combined with fibrin glue spray is a safe and effective treatment in preventing post-ESD stricture of esophageal early cancer.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

* staged as cT1aN0M0 or cT1bN0M0 before surgery via magnifying endoscopy, endosonography, CT, or PET/CT;
* refuse conventional surgery and CRT and got ESD as first-line treatment;
* mucosal defect measured by a circular protractor and reached more than three-quarters of the circumference of the esophageal lumen including whole circumference after ESD surgery;
* meet the minimum follow-up period of three months;
* signed the consent before ESD;
* If extra treatment is needed after ESD, it is up to current guidelines.

Exclusion Criteria:

* excessive bleeding and perforation happened during the ESD procedure;
* excessive bleeding and perforation happened during TA injection;
* loss to follow-up or not meet three months follow-up periods;
* allergy to triamcinolone or fibrin glue;
* esophageal recurrence in situ during follow-up period