Case Report
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World J Gastroenterol. Sep 7, 2014; 20(33): 11910-11915
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11910
Novel method to prevent gastric antral strictures after endoscopic submucosal dissection: Using triamcinolone
Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Kazi Rafiq, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki
Noriko Nishiyama, Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Makoto Oryu, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan
Kazi Rafiq, Departments of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa 761-0796, Japan
Author contributions: All authors contributed significantly, and have read and approved the final version of the manuscript; Nishiyama N led the study and wrote the manuscript; Mori H, Kobara H, Fujihara S, Matsunaga T, Ayaki M, Yachida T, Oryu M and Masaki T researched the case report and Rafiq K critically revised the manuscript.
Correspondence to: Noriko Nishiyama, MD, Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0796, Japan. n-nori@med.kagawa-u.ac.jp
Telephone: +81-87-8912156 Fax: +81-87-8912158
Received: January 19, 2014
Revised: March 19, 2014
Accepted: April 21, 2014
Published online: September 7, 2014
Abstract

Endoscopic submucosal dissection (ESD) of large gastric lesions often leads to severe gastric strictures, especially in cases of large ESD in the antrum of the stomach. It has recently been reported that balloon dilation, mucosal incision, and local steroid injections can successfully treat gastric strictures. However, there are some complications with existing methods and decreasing the quality of life. We have developed a novel method to prevent severe gastric strictures that does not involve balloon dilation, mucosal incision, or steroid injections after circumferential ESD. Our original method involves the submucosal injection of a mixed solution composed of triamcinolone acetonide and a general solution of glycerol, hyaluronic acid, and a small amount of indigo carmine and epinephrine during the ESD procedure; this mixture is called a mixed solution of triamcinolone (MST). According to standard ESD procedures, several milliliters of MST are injected into the submucosal layer for the purpose of elevating the submucosa during ESD resulting in prevention of severe strictures. Our method using MST take several advantages such as MST method suppress inflammation in ulcer from initial phase, prevention of stricture without obstructive symptoms, and does not require several ballooning. Therefore, MST method is safe and gentle, shorten the hospitalization duration. Here, we described two cases in which we prevented severe strictures of the gastric antrum after completing a circumferential ESD using MST without any complications.

Keywords: Early gastric cancer, Endoscopic submucosal dissection, Stricture of antrum, Triamcinolone

Core tip: Endoscopic submucosal dissection (ESD) leads to severe gastric strictures, especially in cases of large ESD in the antrum of the stomach. It has recently been reported that some methods can treat gastric strictures, however there are some limitations. We have developed a novel method to prevent severe gastric strictures that does not involve previous methods. Our original method involves the submucosal injection of a mixed solution composed of triamcinolone acetonide and a general solution during the ESD procedure. Here, we described two cases in which we prevented severe strictures of the gastric antrum after ESD using our original method without any complications.