Local steroid injection prevent deformity and stenosis of stomach after large endoscopic submucosal dissection

Background and Aims: Endoscopic submucosal dissection (ESD) involving more than three fourths (75%) of the gastric lumen creates stenosis of the stomach. This study aims to evaluate the capability to prevent the stenosis those cases by local triamcinolone acetonide (TA) injection. Methods: Among 352 patients, 83 patients underwent resection of more than a half (50%) of the circumference. We retrospectively evaluated 83 patients between September 2008 and August 2012 without local steroid injection (non-TA injection, n=43), and between September 2012 and February 2014 with local steroid injection (TA injection group, n=40). TA was locally injected into the postESD ulcer floor on days 5 and 12. In each groups, we evaluated passage of the endoscope as a marker for stenosis on post-operative day (POD) 30 after ESD. Results: In non-TA group, resections over 75% of the circumference had stenosis that did not allow for passage of the endoscope. Even though local TA injection was performed, only in 5 patients, resections over 75% of the circumference resulted in stenosis that did not allow for passage of the endoscope (P=0.001). Endoscopic balloon dilatation was required 18.6±3.62 times in non-TA group and 5.63±2.86 times in TA group, respectively (P=0.003). Conclusions: Although the local injection of TA into the large artificial ulcer following ESD may prevent postoperative gastric stenosis, more than 75% of the circumference resection leads to severe stenosis even in TA injection. Local TA injection to post-ESD large artificial ulcer was new and innovative measurements to reduce severe stenosis.