Efficacy of different steroid therapies in preventing esophageal stricture after endoscopic submucosal dissection: a comparative meta-analysis.

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is currently the standard therapy for superficial esophageal cancer (SEC). However, postoperative mucosal defects often lead to esophageal stricture. Although steroid application is effective prophylaxis, the efficacy and safety of various steroid administration modes remain unclear. Thus, this study aimed to evaluate the efficacy and safety of different steroid administrations for SEC patients after ESD.

METHODS

A search for relevant studies was conducted on China National Knowledge Infrastructure, Wanfang Database, PubMed, Embase, and Web of Science up to March 25, 2024. Treatment strategies were categorized into 4 groups: no prevention as control (CON), steroid injection (SI), oral steroid (OS), and SI combined with OS (SI+OS). A comparative meta-analysis was conducted to assess outcomes, including postoperative esophageal stricture rate and the number of endoscopic balloon dilation (EBD) sessions required after stricture.

RESULTS

A total of 25 studies, involving 1555 patients, were included. The surface under the cumulative rankings were as follows: SI+OS (98.9%) > OS (59.9%) > SI (41.2%) > CON (0.0%) in preventing postoperative esophageal stricture, and OS (76.9%) > SI+OS (62.1%) > SI (61.0%) > CON (0.0%) in the number of EBD sessions required. Forest plot results indicated that compared with the nonsteroid group, steroid interventions were associated with lower rates of postoperative stricture and fewer EBD sessions. Additionally, SI+OS was superior to SI or OS alone in preventing stricture, with no significant differences observed between different steroid administrations in terms of EBD sessions. The incidence of adverse reactions was <10% for all interventions, mostly mild and resolvable upon discontinuation.

CONCLUSION

This study suggests that combined administration appears preferable for preventing esophageal stricture in patients after ESD and that steroids could enhance stricture prognosis. However, owing to the lack of large-sample randomized controlled trials comparing different steroid administrations, more high-quality research is necessary to confirm these findings in the future.