Useful strategies to prevent severe stricture after endoscopic submucosal dissection for superficial esophageal neoplasm

Figure 1 Representative endoscopic imaging of a stricture after circumferential endoscopic submucosal dissection for a large-sized superficial esophageal squamous cell carcinoma. A: Lugor chromoendoscopy imaging; B: Circumferential post-ESD ulceration; C: ESD specimen; D: Endoscopic imaging of post-ESD stricture 3 mo after ESD. ESD: Endoscopic submucosal dissection.

Figure 2 Representative histological findings of specimens surgically obtained from patients with post-endoscopic submucosal dissection strictures of the esophagus (magnification × 40). A: Hematoxylin-Eosin staining; B: Elastica-Masson staining. These results indicated rich collagen fibers with inflammatory cells in the submucosa and atrophic changes in muscularis proper at the stricture site.

Figure 3 Representative endoscopic images of refractory strictures of the esophagus. A: Endoscopic images immediately after 10-cm long circumferential ESD; B: Images 3 mo after ESD followed by repeated EBD with steroid injection; C: ERIC procedure with IT-2 knife (Olympus, Tokyo, Japan); D: Severe stricture 1 mo after ERIC. ESD: Endoscopic submucosal dissection; ERIC: Endoscopic radial incision and cutting; EBD: Endoscopic balloon dilation.

Figure 4 Representative image of esophageal perforation 2 d after local injection of triamcinolone acetonide for endoscopic submucosal dissection ulceration.

Figure 5 Representative image of the ulcer healing process after circumferential endoscopic submucosal dissection of the esophagus. A: 3 wk after ESD of patient without Tranilast intake; B: 16 wk after ESD of patient without Tranilast intake; C: 3 wk after ESD of patient with Tranilast intake; D: 16 wk after ESD of patient with Tranilast intake. ESD: Endoscopic submucosal dissection.