Stricture Prevention after Extensive Endoscopic Submucosal Dissection of Neoplastic Barrett’s Esophagus: Individualized Oral Steroid Prophylaxis

Figure 3

Examples for ESD and stricture prevention in large Barrett’s neoplasia. (a) Early adenocarcinoma 40 mm in diameter within BE C7M8. (b) Resection ulcer after ESD involving 80% of the circumference. (c) First control endoscopy on d16 after ESD (prednisolone dose 30 mg): rapid reepithelialization, no stricture, mild dysphagia, and standard steroid tapering. (d) Second control endoscopy on d43 after ESD (prednisolone dose 10 mg): complete ulcer healing without stricture, standard steroid tapering (duration 8 weeks). (e) Multifocal early adenocarcinoma within BE C4M6. (f) Resection ulcer after ESD involving 90% of the circumference. (g) First control endoscopy on d12 after ESD (prednisolone dose 40 mg): no rapid reepithelialization, no stricture, no dysphagia, and standard steroid tapering. (h) Second control endoscopy on d47 after ESD (prednisolone dose 10 mg): residual ulcer without narrowing of the lumen. Prolongation of steroid tapering (duration 10 weeks). (i) Endoscopy on day 80 after ESD: complete ulcer healing without stricture.

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