Prevention of Esophageal Strictures After Endoscopic Submucosal Dissection: A Promising Therapy Using Carboxymethyl Cellulose Sheets.

BACKGROUND: Esophageal stricture is one of the serious adverse events following endoscopic submucosal dissection (ESD). However, optimum preventive techniques are still lacking. AIMS: Our primary objective was to evaluate the incidence of post-ESD esophageal stricture with the application of carboxymethyl cellulose (CMC) sheets. Secondary objectives were to determine the number of sessions of endoscopic balloon dilatation (EBD) required to resolve post-ESD strictures and the incidence rate of peri-operative adverse events. METHODS: This was a pilot, single-center, prospective study. Seven patients who had high risks of developing post-ESD esophageal stricture were enrolled into our study. CMC sheets were applied to the mucosal defects immediately after the completion of ESD. Patients were monitored and reviewed after ESD to detect any adverse events. RESULTS: The incidence rate of post-operative stricture was 57 % (4/7 patients). Among patients who required EBD, the number of sessions performed was 2.8 ± 2.2. No serious post-operative adverse events were reported. CONCLUSION: The use of CMC sheets appears to be a safe and effective prophylactic treatment for esophageal stricture following extensive ESD.

Fibrin Glue Spray as a Simple and Promising Method to Prevent Bleeding after Gastric Endoscopic Submucosal Dissection.

AIM: This study was conducted to evaluate the effectiveness of fibrin glue (FG) in preventing delayed bleeding after gastric endoscopic submucosal dissection (ESD). METHODS: From 2011 to 2014, 423 patients undergoing gastric ESDs were studied retrospectively. After excluding 26 patients, 397 were enrolled. The post-ESD wounds were treated with only coagrasper/clips before April 2013. After that, additional FG spray was utilized for wound closure. The post-ESD bleeding rates were compared between the FG group (patients with postoperative use of FG) and the non-FG group (patients without the use of FG). RESULTS: A total of 397 lesions were successfully resected from 397 patients. The FG group significantly had more risk factors predisposing to delayed bleeding, such as advanced age, larger specimen size, more cancerous lesions and longer operation time. There was no significant difference in gender, comorbidity, lesion locations, numbers of coagrasper and hemoclips used between the 2 groups. The total rate of delayed bleeding was 4.53% (18/397). There were 18 cases of delayed bleeding (5.98%) in the non-FG group and none in the FG group (p = 0.03). Univariate analysis showed that FG reduced the risk of delayed bleeding significantly (p = 0.03). CONCLUSION: FG was simple and effective in preventing delayed bleeding after gastric ESDs.

Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis?

BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce the incidence of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). There were various trials using different routes and dosages of NSAIDs but meta-analysis revealed inconsistent results. AIMS: The aims of this study were to determine the efficacy of rectal diclofenac in preventing PEP and to evaluate any adverse events. METHODS: This was a randomized, open-label, two-arm, prospective clinical trial. Only patients at high risk of developing PEP were recruited. They received 100 mg rectal diclofenac or no intervention immediately after ERCP. The patients were reviewed 30 days after discharge to evaluate any adverse event. RESULTS: Among 144 recruited patients, 69 (47.9%) received diclofenac and 75 (52.1%) had no intervention. Eleven patients (7.6%) developed PEP, in which seven were from the diclofenac group and four were in the control group. Eight cases of PEP (5.5%) were mild and three cases (2.1%) were moderate. The differences in pancreatitis incidence and severity between both groups were not statistically significant. There were 11 adverse events reported. Clinically significant bleeding happened in four patients (2.8%): one from the diclofenac group and three from the control group. Other events included cholangitis: two patients (2.9%) from the diclofenac group and four (5.3%) from the control group. One patient from the diclofenac group (1.4%) had a perforation which was treated conservatively. CONCLUSIONS: In summary, prophylactic rectal diclofenac did not significantly decrease the incidence of PEP among patients at high risk for developing PEP. However, the administration of diclofenac was fairly safe with few clinical adverse events.