Steroid with Temporary Stent Versus Steroid Alone for Preventing Stricture After Endoscopic Submucosal Dissection for...

Post-ESD esophageal stricture remains a major complication despite steroid prophylaxis. Temporary stent placement has been proposed as an adjunctive strategy in high-risk cases, yet its independent effect remains uncertain due to treatment selection bias. We aimed to evaluate the association between adjunctive stent placement and post-ESD stricture using multiple adjustment strategies, including inverse probability of treatment weighting (IPTW).

In this retrospective cohort study of 89 patients receiving standardized steroid prophylaxis, 31 additionally underwent temporary fully covered self-expanding metal stent placement. Multivariable logistic regression, IPTW, and doubly robust models were applied to address baseline imbalances.

Conventional multivariable adjustment did not demonstrate a statistically significant association between stent placement and stricture (aOR 2.07, 95% CI 0.68-6.31). However, after IPTW adjustment with adequate covariate balance (all standardized mean differences < 0.1), stent placement was associated with increased stricture risk (OR 2.39, 95% CI 1.21-4.73). This finding persisted in doubly robust analysis (OR 2.55, 95% CI 1.24-5.25). Increasing age was independently associated with stricture across models.

Analytical approach substantially influenced effect estimates. While conventional regression did not detect a significant association, IPTW-based analyses suggested a potential increase in stricture risk with adjunctive stenting. These findings underscore the importance of addressing treatment selection bias and warrant prospective validation.