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Prediction of post-ESD esophageal stricture by a nomogram and risk factor analysis of ineffective oral steroids prophylaxis

  • 0Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road, No.1095, Wuhan, Hubei, China.
Bmc Gastroenterology +

|

October 10, 2024

|

October 10, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

A new nomogram predicts esophageal stricture risk after endoscopic submucosal dissection (ESD). High-risk patients, especially those with extensive mucosal defects, may not benefit from oral steroids due to potential glucocorticoid resistance.

Area Of Science

  • Gastroenterology
  • Oncology
  • Endocrinology

Background

  • Esophageal stricture is a complication of endoscopic submucosal dissection (ESD).
  • Existing risk models for post-ESD stricture often omit steroid use.
  • The role of glucocorticoid receptor (GR) expression in esophageal stricture development is underexplored.

Purpose Of The Study

  • To develop a predictive nomogram for esophageal stricture following ESD.
  • To identify risk factors for ineffective oral steroid prophylaxis.
  • To investigate the association between GR expression and esophageal stricture.

Main Methods

  • A logistic regression model was used to create a nomogram incorporating clinical and endoscopic factors.
  • Risk factors for ineffective oral steroid prophylaxis were analyzed in 92 patients.
  • Glucocorticoid receptor (GR) expression was assessed using immunohistochemistry.

Main Results

  • A nomogram was developed using data from 314 patients, considering lesion circumference, longitudinal diameter, and location.
  • A total score >36 indicated a high risk of esophageal stricture.
  • Circumferential mucosal defects (≥7/8) were linked to ineffective oral steroid prophylaxis (OR 12.2).
  • Higher GR-β expression was observed in patients with strictures.

Conclusions

  • A novel nomogram aids in predicting post-ESD esophageal stricture risk.
  • Risk stratification allows for tailored treatment strategies, including considering alternatives for high-risk cases.
  • Elevated GR-β expression suggests potential glucocorticoid resistance in some patients.

Keywords:

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