Novel method to prevent gastric antral strictures after endoscopic submucosal dissection: Using triamcinolone

Figure 1 We treated a case of severe stenosis in the antrum after the endoscopic submucosal dissection procedure. The circumferential extent of the mucosal defect was > 3/4. A: The white arrow shows that the lesion constituted of a semi-circumferential, laterally spreading type 0-IIc early gastric cancer on the anterior wall of the antrum; B: The circumferential extent of the mucosal defect was > 4/5 after the performance of the ESD procedure; C: Three months after the endoscopic submucosal dissection operation, the patient experienced a severe stricture of the gastric antrum. Subsequently, we had to perform a mucosal incision and local steroid injection.

Figure 2 Schematic diagram of our proposed new method. Schematic diagram of our proposed new method consists of submucosal injection of a mixture of solution containing triamcinolone acetonide 8 mL, glycerol 16 mL, and hyaluronic acid 16 mL, in addition to a small amount of indigo carmine and epinephrine, which was injected during the performance of the endoscopic submucosal dissection (ESD). The lesions were treated by standard ESD procedures.

Figure 3 We performed our proposed new method during endoscopic submucosal dissection at gastric antrum (Case 1). A: Endoscopic imaging showed that the lesion constituted a semi-circumferential, laterally spreading type 0-IIc early gastric cancer in the posterior wall of the antrum (white arrow); B: A three-fourths circumferential mucosa in the antrum was removed by standard endoscopic submucosal dissection (ESD) procedure; C: The day after the ESD operation, there was abundant vascularization in the ESD ulcer; D: Two weeks after the ESD operation, there was more granulation tissue than in a typical ESD ulcer; E: Three months after the ESD operation, there were no strictures concomitant with the healing process near the ESD ulcer.

Figure 4 We performed our proposed new method during endoscopic submucosal dissection at gastric antrum (Case 2). A: Endoscopic imaging showed that the lesion constituted a one-third circumferential, laterally spreading type 0-IIc early gastric cancer on the anterior wall of the antrum (white arrow); B: A three-fourths circumferential mucosa in the antrum was removed by standard endoscopic submucosal dissection (ESD) procedure; C: The day after the ESD, there was abundant vascularization in the ESD ulcer; D: Two weeks after the ESD operation, there was more granulation tissue than usual in the ESD ulcer; E: Three months after the ESD operation, there were no strictures concomitant with the healing process near the ESD ulcer.