The RIC procedure was performed as described previously (
7 (link)
. The patients received pethidine hydrochloride and/or midazolam immediately before the start of the RIC procedure. All RIC procedures were performed with an IT diathermic knife (KD-610 L, IT knife/IT knife-2, Olympus, Tokyo, Japan) using ordinary-sized endoscopes (GIF-Q260, Q260 J, or H290; Olympus) by expert endoscopists who had performed more than 100 cases of esophageal ESD. The RIC procedure was as follows: (1) the stricture area was incised radially using an IT knife; (2) an imaginary line that connects the esophageal lumen on the oral side and the lumen on the anal side was assumed; (3) a vertical incision was performed radially to the stricture along this line; (4) the incision area was sliced off; (5) the surface of the tight fibrotic area was shaved with a short-pronged blade of the IT knife; (6) the lumen was scraped with biopsy forceps as needed; (7) steps three to six were repeated; and (8) we confirmed that an ordinary-sized endoscope could pass through the stricture site; we used a thinner endoscope (XP260, XP260N, or XP240; Olympus) in the case of severe stricture. In addition, steroid (triamcinolone acetonide basically 50 mg) was injected into the stricture site immediately after RIC, mainly in cases with the long stricture at the discretion of the endoscopist although there were no clear criteria. The same method was performed for the repeated RIC. RIC procedures were basically performed at outpatient clinic. The patients rested at recovery room for 2 hours after the RIC procedure, and they were allowed to drink water after rest. And they were also allowed food intake at 4 hours after the RIC procedure.
