Hyperbaric oxygen and steroids for preventing stricture after large esophageal endoscopic submucosal dissection

Treatment of esophageal mucosal lesions by endoscopic submucosal dissection (ESD) may lead to the formation of esophageal strictures. This trial was designed to clarify efficacy of hyperbaric oxygen therapy (HBOT)-assisted steroids in preventing postoperative strictures after ESD for large and long-segment esophageal mucosal lesions.

Between October 2020 and July 2023, patients who underwent esophageal ESD with a remained mucosal defect of more than three-quarters of the esophageal circumference and longer than 50 mm in diameter were retrospectively analyzed. Patients in the control group were administered one injection of triamcinolone acetonide in the submucosal layer and oral prednisone, whereas patients in the experimental group underwent HBOT along with the abovementioned steroid therapy. Furthermore, differences in postoperative stricture incidence and related adverse events between the two groups were evaluated.

A total of 35 patients were included in this study. Patients in the experimental group had a significantly lower stricture incidence compared with those in the control group (6.7%, 1/15 patients vs 40%, 8/20 patients; P = 0.048). Stricture incidence of circumferential mucosal defects was significantly lower in the experimental group than in the control group (0.0%, 0/6 patients vs 71.4%, 5/7 patients; P = 0.021). Incidence of post-ESD complications was similar in both groups (6.7%, 1/15 patients vs 25%, 5/20 patients; P = 0.207). No HBOT-related AEs were observed.

HBOT-assisted steroid therapy might be a safe and effective way to prevent postoperative strictures after ESD for large and long-segment esophageal mucosal lesions.