Esophageal stricture after endoscopic submucosal dissection for esophageal cancer
Conditions
Interventions
Arm A: Endoscopic balloon dilation for the post-ESD esophageal stricture.
Arm B: Endoscopic balloon dilation combined with local triamcinolone or prednisolone injection of 40 mg/4 mL at the margin of
Sponsors
Yano Tomonori
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1st inclusion criteria (1) Meet all the following about endoscopic submucosal dissection (ESD) for thoracic esophageal or esophagogastric junction cancer: (a) Meet either of the following. (i) For a single lesion: non-circumferential lesion measuring 8 cm or less in the longitudinal axis, or circumferential lesion measuring 5 cm or less in the longitudinal axis (ii) For synchronous multiple lesions: major lesion and adjacent sub-lesions are non-circumferential and the entire target lesion has a longitudinal axis of 8 cm or less, or major lesion is circumferential and the entire target lesion has a longitudinal axis of 5 cm or less. All non-adjacent sub-lesions are less than 1/2 circumferential. (b) En bloc resection and no macroscopic residual tumor. (c) Histologically proven squamous cell carcinoma, basaloid carcinoma, adenosquamous carcinoma, or adenocarcinoma. (d) Histologically diagnosed pVM0. (2) No rule on whether and how to prevent post-ESD stricture. (3) Dysphagia score >=1. (4) Meet either of the following criteria in terms of endoscopic balloon dilation (EBD) for post-ESD stricture (a)No prior dilation therapy (b) Only one EBD alone and the period between that EBD and the secondary enrollment can be at least 14 days (the same day of the week two weeks later is acceptable). (5) Age >=18 (6) Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. (7) No prior treatment for esophageal cancer other than endoscopic resection (8) No history of metachronous multiple esophageal cancers unless all of the following are met. (a) Prior endoscopic resection (b) No macroscopic residual tumor. (c) Histologically proven squamous cell carcinoma, basaloid carcinoma, adenosquamous carcinoma, or adenocarcinoma. (d) Histologically diagnosed pVM0. (e) No post esophageal ESD stricture with scarring confirmed by a surveillance endoscopy, or a resolved post ESD esophageal stricture confirmed by a follow up endoscopy 4 weeks or later after dilation therapies. (9) No history of head and neck cancer unless all of the following are met. (a) No evidence of recurrence. (b) No post ESD stricture with scarring confirmed by a surveillance endoscopy, or a resolved post ESD esophageal stricture confirmed by a follow up endoscopy 4 weeks or later after dilation therapies (10) No prior chemotherapy for any cancer within 28 days before registration, and no plan of chemotherapy within 24 weeks after registration. (11) No prior radiotherapy to the neck, chest wall, lung, or mediastinum (12) Sufficient organ function (a) White blood cell count >=2,000/mm3 and =8.0 g/dL. (c) Platelet >=100,000/mm3. (d) Total bilirubin <=2.0 mg/dL. (e) Aspartate aminotransferase <=150 U/L. (f) Alanine aminotransferase <=150 U/L. (g) Creatinine <=2.0 mg/dL. (13) Written informed consent 2nd inclusion criteria (1) Within 28 days from the first registration. (2) No treatment for post-ESD stricture has been done since the first registration. (3) If a patient has received a single dose of EBD for post-ESD esophageal stricture before the first registration, it has been more than 14 days since the EBD. (4) All of the following are met with the latest follow-up endoscopy performed within 28 days before the second registration. (a) There is a post-ESD stricture in the thoracic esophagus that the endoscope (9.8-9.9 mm in diameter) does not pass through. Pinhole stricture which an EBD balloon catheter cannot pass through is ineligible. (b) No strictur
Exclusion criteria
Exclusion criteria: (1) Active infection requiring systemic therapy. (2) Body temperature >=38 degrees Celsius. (3) Pregnancy, possible pregnancy, within 28 days after delivery or breastfeeding. (4) Severe psychiatric disease. (5) Receiving continuous systemic steroid or immunosuppressant treatment except steroid for the prevention of stricture after ESD for esophageal cancer. (6) Patients requiring continuous anticoagulant or antiplatelet drug. (7) Poorly controlled hypertension. (8) History of unstable angina within 3 weeks or myocardial infarction within 6 months.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Time to post-ESD esophageal stricture resolution | — |
Secondary
| Measure | Time frame |
|---|---|
| Proportion of patients who required rescue EBD, Number of endoscopic balloon dilation for 24 weeks, proportion of patients with dysphagia score 0 at the time of 24 weeks after treatment, adverse events, PRO-CTCAE (difficulty swallowing, decreased appetite, nausea, vomiting, heartburn) | — |
Contacts
Public ContactTomohiro Kadota
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East
Outcome results
None listed