Risk Factors and Prophylaxis for Post-Procedural Stricture After Esophageal Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) is the standard treatment for superficial esophageal neoplasms; however, post-procedural stricture remains a significant challenge. The risk factors and prophylaxis for post-procedural stricture in 128 lesions treated with esophageal ESD over 12 years, were analyzed. There was a stricture in 13 lesions (10.2%), with rates of 2.0%, 1.9%, and 44.0% for lesions with a <50%, 50% to 75%, and >75% circumferential extent of the post-ESD mucosal defect, respectively (p<0.001). Prophylactic treatments included no prophylaxis (40.6%), local triamcinolone injection (42.2%), and combined triamcinolone injection plus oral prednisolone (17.2%). In univariate analysis, older age, larger tumor and specimen size, higher Japan Esophageal Society classification, longer procedure time, and a >75% extent of circumferential mucosal defect, were associated with stricture. In multivariate analysis adjusted for age, a >75% extent of circumferential mucosal defect remained independently associated with stricture (adjusted odds ratio, 34.773; 95% confidence interval, 6.880-175.747; p<0.001). The circumferential extent of the post-ESD mucosal defect was the strongest risk factor for post-ESD stricture.