Wang QX, Ding Y, Qian QL, Zhu YN, Shi RH. Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application. World J Gastrointest Endosc 2024; 16(9): 509-518 [PMID: 39351179 DOI: 10.4253/wjge.v16.i9.509]
Corresponding Author of This Article
Rui-Hua Shi, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Medical School, No. 87 Dingjiaqiao, Gulou District, Nanjing 210009, Jiangsu Province, China. ruihuashi@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Sep 16, 2024; 16(9): 509-518 Published online Sep 16, 2024. doi: 10.4253/wjge.v16.i9.509
Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application
Qing-Xia Wang, Yuan Ding, Qi-Liu Qian, Yin-Nan Zhu, Rui-Hua Shi
Qing-Xia Wang, Yuan Ding, Qi-Liu Qian, Yin-Nan Zhu, Rui-Hua Shi, Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Medical School, Nanjing 210009, Jiangsu Province, China
Author contributions: Wang QX design the study and write the report; Ding Y, Qian QL and Zhu YN collect, analyze, and interpret the data; Shi RH provide guidance on thesis design; all authors agree to submit for publication.
Supported byJiangsu Province Chinese Medicine Science and Technology Development Program, No. ZT202119.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: No benefits in any form have been received. All authors declare there are no conflicts of interest regarding the publication of this paper.
Data sharing statement: No data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rui-Hua Shi, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Medical School, No. 87 Dingjiaqiao, Gulou District, Nanjing 210009, Jiangsu Province, China. ruihuashi@126.com
Received: June 21, 2024 Revised: August 21, 2024 Accepted: August 29, 2024 Published online: September 16, 2024 Processing time: 82 Days and 21.6 Hours
Abstract
BACKGROUND
Endoscopic submucosal dissection (ESD) is a reliable method to resect early esophageal cancer. Esophageal stricture is one of the major complications after ESD of the esophagus. Steroid prophylaxis for esophageal strictures, particularly local injection of triamcinolone acetonide (TA), is a relatively effective method to prevent esophageal strictures. However, even with steroid prophylaxis, stenosis still occurs in up to 45% of patients. Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients.
AIM
To identify the predictors of esophageal strictures after steroids application.
METHODS
Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion- and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study. The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis.
RESULTS
A total of 120 patients were included in the analysis. In the oral prednisone and oral prednisone combined with local tretinoin injection groups, the stenosis rates were 44/53 (83.0%) and 56/67 (83.6%), respectively. Among them, univariate analysis showed that the lesion circumference (P = 0.01) and submucosal injection solution (P = 0.04) showed significant correlation with the risk of stenosis formation. Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports, such as additional chemoradiotherapy and tumor location. We identified a lesion circumference < 5/6 (OR = 0.19; P = 0.02) and submucosal injection of sodium hyaluronate (OR = 0.15; P = 0.03) as independent predictors of on esophageal stricture formation.
CONCLUSION
Steroid prophylaxis effectively prevents stenosis. Moreover, the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures. Additional interventions should be considered in high-risk patients.
Core Tip: Steroid administration can help prevent post-esophageal endoscopic submucosal dissection (ESD) stricture. This study was clarified the risk factors of stricture even with steroid administration. Although steroids were administered to prevent esophageal strictures after ESD, the lesion circumference and submucosal injection of sodium hyaluronate remained independent predictors of esophageal stricture formation. Among them, submucosal injection of sodium hyaluronate was the first influential factor that may be a guide for clinical prevention.
