食管ESD术后狭窄防治PPT课件

G(seenv重eerrae症lisni感fdeec染teioffne,cptseptic ulce消r, h化yp性erg溃lyc疡emia, psy高chia血tri糖c symptoms, and oste精op神oro症sis状)
Dela骨ye质d w疏ou松nd healing
Inhibits the infiltration of
1、Oral steroids
• Partially effective, easy to do • No RCT available • Drawback: adverse events
2、Local injection of steroids
• Easy to do • RCT available • Partially effective • Drawback: a delayed perforation was reported
esophagus • History of chemo-radio therapy
GIE 2011;74(6):1389-1393
全身使用皮质类固醇
长期使用导致感染、骨质疏松症、糖尿病、视力下降等不良反应
Clinical study
Action
Corticosteroids
Steroidal
Triamcinolone acetonide Steroidal Pre-clinical study
post-ESD 食管狭窄防治方法
预防性系列扩张 腔内注射内固醇药物/局部类固醇凝胶 全覆膜金属支架 聚乙醇酸（PGA）片和纤维蛋白胶 放射状切开/环状切除 组织工程及再生医学 自体粘膜移植
Minerva Chir 2018;73:394-409.
List of methods, which could be, at present, considered in clinical practice
undergoing extensive ER/ESD.
Study
N.
Diagnosis Extent of the circumference Stricture rate
van Vilsteren FG4* 25 BE, AC or HGD
Park JS8*
5
SCC
Ono S7*
10
SCC
Katada C6*
infla抗mm炎atory cells, the hwyitphe抗rgpr肉laansui芽alaat组sioson织c, iaanteddthe fibro抗sis纤of 维the化remaining
submucosal layer
Rdinuitseok注形ttoohf射成eaucmlcc部风eiudrse位险cfnoutrlaam溃lraiisn疡tijoecntion 延缓伤口愈合
The risks of perforation and secondary malignancy
3、Stenting
• Only fully covered metallic stents appropriate • Easy to do • RCT available • Limited efficacy • Drawback: no clear data on stent removal, the need for fixation to decrease migration rate
ESD术后食管狭窄的防治
中国人民解放军陆军军医大学新桥医院 重庆市消化疾病临床医学研究中心
1
ESD适应症
Techniques in Gastrointestina lEndoscopy 19(2017)159–169
Risk of stricture formation in patients
Strongly inhibits the
iinnffillat抗mramt炎ioantooryf cells, the hype抗rp肉lasi芽a a组sso织ciated with抗gr纤anu维lat化ion, and the
fibrosis of the remaining submucosal layer
MMC
Inhibition of DNA synthesis
N-acetylcysteine
Antioxidant molecule
Administration
Advantages
Disadvantages and limitations
Oral intake Local injection
Local injection Oral intake
Minerva Chirurgica 2018;73(4):394-409
球囊扩张术/内固醇药物
Characteristics of steroid refractory case • Resected circumference: 9/10 or more • Resected longitudinal diameter: 50 mm • Location of esophagus: cervical
19 SCC, HGD and AC
Wen J9*
7
SCC
*No preventive strategy used.
≥75% ≥75% ≥75% ≥75% ≥75%
88% 83% 90%
71%
1.对抗炎药的系统性用药； 2.局部注射消炎或抗纤维原物质； 3.单纯的内镜方法（支架、扩张）； 4.组织工程方法--细胞治疗； 5.胃粘膜移植到食管； 6.各种其他办法
Delayed wound healing
In抑hib制its 纤the维pro母lif细era胞tion afinb活droab化cltaisv与tast增ion生ofቤተ መጻሕፍቲ ባይዱ
An effect has not been shown for the prevention of esophageal strictures, although MMC improves recurrent dysphagia or restenosis after the dilatation of esophageal strictures