Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2023; 11(5): 1158-1164
Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1158
Combined treatment of refractory benign stricture after esophageal endoscopic mucosal dissection: A case report
Wen-Feng Pu, Tao Zhang, Zong-Han Du
Wen-Feng Pu, Tao Zhang, Zong-Han Du, Department of Gastroenterology, Nanchong Central Hospital, The Second Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Author contributions: Pu WF wrote and edited the original draft and reviewed the literature; Zhang T assisted with the patient’s treatment, provided clinical advice, and approved the final manuscript; Du ZH conducted and reviewed the patient’s treatment; All authors have read and approve the final manuscript.
Supported by The Sichuan Medical Association Digestive Endoscopy Special Committee Special Topic, China, No. 2021XHNJ05.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Feng Pu, MM, Doctor, Department of Gastroenterology, Nanchong Central Hospital, The Second Affiliated Hospital of North Sichuan Medical College, No. 97 Renmin South Road, Shunqing District, Nanchong 637000, Sichuan Province, China. 1047951869@qq.com
Received: November 8, 2022
Peer-review started: November 8, 2022
First decision: November 23, 2022
Revised: December 6, 2022
Accepted: January 20, 2023
Article in press: January 20, 2023
Published online: February 16, 2023
Processing time: 97 Days and 17.1 Hours
Abstract
BACKGROUND

Endoscopic submucosal dissection (ESD) post-procedure stricture is a relatively common long-term complication following ESD treatment. A range of approaches has been implemented for the treatment of post-procedural stricture using endoscopic techniques such as endoscopic dilation, self-expandable metallic stent insertion, local steroid injection in the esophagus, oral steroid administration, radial incision and cutting (RIC). The actual efficacy of these different therapeutic options is highly variable, and uniform international standards for the prevention or treatment of stricture.

CASE SUMMARY

In this report, we describe the case of a 51-year-old male diagnosed with early esophageal cancer. To protect against esophageal stricture, the patient was administered oral steroids and underwent self-expandable metallic stent insertion for 45 d. Despite these interventions, stricture was detected at the lower edge of the stent following its removal. The patient remained refractory to multiple rounds of endoscopic bougie dilation treatment, and thus suffered from complex refractory benign esophageal stricture. As such, RIC combined with bougie dilation and steroid injection was employed to treat this patient more effectively, ultimately achieving satisfactory therapeutic efficacy.

CONCLUSION

Combination of RIC, dilation, and steroid injection can be safely and effectively implemented to treat cases of post-ESD refractory esophageal stricture.

Keywords: Endoscopic submucosal dissection; Radial incision and cutting; Benign stricture; Early esophageal cancer; Stent insertion; Case report

Core Tip: Endoscopic submucosal dissection post-procedure stricture is one of the most common long-term complications of the procedure. At present, there is no uniform international standard on how to effectively prevent and treat stricture after resection of large esophageal lesions. we selected to attempt to treat complex refractory esophageal stricture through a combination of radial incision and cutting, dilation, and steroid injection. Satisfactory results were achieved.