Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13264
Peer-review started: August 28, 2022
First decision: October 5, 2022
Revised: October 22, 2022
Accepted: December 5, 2022
Article in press: December 5, 2022
Published online: December 26, 2022
Processing time: 120 Days and 4.5 Hours
Esophageal stenosis is one of the main complications of endoscopic submucosal dissection (ESD) for the treatment of large-area superficial esophageal squamous cell carcinoma and precancerous lesions (≥ 3/4 of the lumen). Oral prednisone is useful to prevent esophageal stenosis, but the curative effect remains controversial.
Explore more effective methods to prevent esophageal stenosis after ESD for early esophageal cancer and precancerous lesions.
We shared our experience of the precautions against esophageal stenosis after ESD to remove large superficial esophageal lesions.
Patients with large superficial esophageal squamous cell carcinoma and high-grade intraepithelial neoplasia experienced ESD were enrolled. Prednisone (50 mg/d) was administered orally on the 2nd d after ESD for 1 mo, and tapered gradually (5 mg/wk) for 13 wk.
According to the range of esophageal mucosal defect, 11 cases involved ≥ 3/4 and < 7/8 circumference, 1 case involved ≥ 7/8 circumference, and 2 cases involved the entire circumference. The incidence of esophageal stenosis was 0% (0/14), and only 1 patient developed esophageal Candida infection on the 30th d after ESD and recovered completely after 7d of treatment with oral fluconazole 100 mg/d.
Further investigation of larger samples is required to warrant feasibility and safety.
In conclusion, increasing the dose of oral prednisone (50 mg/d) and prolonging the usage time (total 13 wk) may effectively prevent esophageal stenosis after ESD removing large-area superficial esophageal squamous cell carcinoma or precancerous lesions of esophagus, and does not increase the incidence of glucocorticoid-related adverse events.