布地奈德凝胶预防食管内镜黏膜下剥离术后大面积狭窄的价值

Prophylactic value of budesonide viscous suspension for extensive esophageal stenosis after endoscopic submucosal dissection

目的:评估布地奈德凝胶(budesonide viscous suspension,BVS)预防食管内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术后大面积狭窄的有效性和安全性。方法:回顾性分析2014年10月—2018年12月于福建省立医院行ESD,术后黏膜缺损超过1/2周的62例早期食管癌或癌前病变的患者临床资料。根据术后有无接受BVS治疗,分为接受BVS治疗组(BVS组,24例)和未给予BVS组(对照组,38例)。对比两组狭窄发生率、术后探条扩张次数、并发症发生率,并对术后食管狭窄危险因素行Logistic回归分析。结果:BVS组术后狭窄发生率明显低于对照组[16.7%(4/24)比47.3%(18/38),P=0.005],BVS组术后探条扩张次数少于对照组(1.50±0.58比2.70±1.09,P=0.039)。BVS组未发生与BVS相关的严重不良事件,如穿孔和大量出血。经多因素Logistic回归分析,环周≥3/4(OR=37.970,95%CI:6.338~227.482)及术后未予BVS处理(OR=20.962,95%CI:3.374~130.243)是导致术后食管狭窄的独立危险因素。结论:吞服BVS可减少食管ESD术后的大面积狭窄发生率及所需的探条扩张次数,且安全、耐受性良好。

Objective To evaluate the efficacy and safety of budesonide viscous suspension(BVS)in preventing extensive esophageal stenosis after endoscopic submucosal dissection(ESD).Methods Data of 62 cases of early esophageal neoplasms or precancerous lesions receiving ESD whose postoperative mucosal defects were more than half the circumference of the esophageal lumen at Fujian Provincial Hospital from October 2014 to December 2018 were retrospectively studied.The patients were divided into the BVS group who received BVS therapy(n=24)and the control group who received no intervention(n=38).The incidence of postoperative stenosis,the number of bougie dilation procedures and complications were compared between the two groups.Risk factors for postoperative stricture were analyzed by logistic regression.Results The incidence of postoperative stenosis[16.7%(4/24)VS 47.3%(18/38),P=0.005],the number of bougie dilation procedures(1.50±0.58 VS 2.70±1.09,P=0.039)in the BVS group were significantly lower than those in the control group.No serious adverse events such as perforation or massive hemorrhage related to BVS were observed in the BVS group.Multivariate logistic regression analysis showed circumferential extension≥3/4(OR=37.970,95%CI:6.338-227.482)and non-intervention with BVS(OR=20.962,95%CI:3.374-130.243)were the independent risk factors for esophageal stricture after ESD.Conclusion Administration of BVS is an effective and safe method to reduce the incidence of stenosis and the number of bougie dilation procedures for extensive esophageal stenosis after ESD.