Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity
Mori H et al. – Local steroid injection into the floor of a post–ESD artificial ulcer promotes the formation of granulation tissue at an early stage of the healing process leading to regeneration of gastric mucosa without mucosal convergence or gastric deformity.Methods
- A total of 45 patients who were diagnosed with early gastric cancer were enrolled.
- Patients were randomly assigned by the sealed-envelope randomization method to either local TCA injections (n=21) or sham-control (n=20) groups.
- Two clips were placed at the two maximum outer edges of the artificial ulcer after the lesion had been resected (Day 0).
- Local TCA injections were performed on postoperative Day 5 and Day 12.
- The distance between the two clips was measured by endoscopic measuring forceps on Days 5, 12, 30, and 60.
- Granulation formation and gastric deformity were evaluated by visual analog scale (VAS) on Days 30 and 60.
- Local TCA injection did not alter clip-to-clip distance on postoperative Day 60, and formation of flat granulation tissue over the ulcer was followed by regenerative mucosa without any gastric deformity.
- The sham-control group showed significant shortening of clip-to-clip distance compared with the local steroid-injected group and protruded forms of granulation tissue with mucosal convergence.
- Histological evaluation revealed prominent growth of neovessels, swelling, and marked increases in endothelial cells in the local steroid-injected group compared with the sham-control group.