Refractory strictures despite steroid injection after esophageal endoscopic resection

Area of Science:

• Gastroenterology
• Oncology
• Surgical Innovation

Background:

• Steroid injections are used to prevent esophageal strictures post-endoscopic submucosal dissection (ESD).
• Some patients still require multiple endoscopic balloon dilation (EBD) sessions for refractory strictures.
• This study investigates risk factors for refractory stricture despite preventative steroid injections after esophageal ESD.

Purpose of the Study:

• To identify risk factors for refractory esophageal stricture after ESD.
• To assess the safety of steroid injections in preventing esophageal stricture.
• To evaluate the impact of tumor circumferential extent on stricture development.

Main Methods:

• Analysis of 127 patients undergoing esophageal ESD with >75% circumferential mucosal defects.
• Steroid injection administered to prevent stricture.
• Endoscopic balloon dilation (EBD) used for symptomatic dysphagia.

Main Results:

• A tumor circumferential extent >75% was an independent risk factor for refractory stricture (adjusted OR 5.49).
• Patients with refractory stricture had a significantly higher percentage of tumor circumferential extent >75% (P=0.001).
• Major adverse events (perforation) occurred in 2.4% of patients during or after EBD.

Conclusions:

• Tumor circumferential extent >75% predicts refractory stricture despite steroid injections.
• More extensive interventions may be needed to prevent refractory stricture in high-risk cases.
• Steroid injections appear relatively safe, with low rates of major complications.