Risk factors for esophageal stricture after circumferential endoscopic submucosal dissection: a preliminary,...

Post-circumferential endoscopic submucosal dissection (cESD) esophageal stricture remains a refractory complication despite combined steroid therapy (CST). The submucosal steroid pre-injection strategy (SSPS) has emerged as a novel prophylactic approach. This study aimed to preliminarily identify risk factors for post-cESD stricture, with a focus on steroid-based prophylaxis.

This multicenter, retrospective, case-control study utilized the same patient dataset as our previously published cohort study and included 55 patients who underwent cESD with either SSPS or CST prophylaxis across eight tertiary hospitals in China (January 2022-August 2024). Univariate and multivariate logistic regression analyses were performed to identify risk factors by calculating odds ratios (ORs) with 95% confidence intervals (CIs), with subgroup analyses stratified by prophylactic measures.

The stricture and non-stricture groups comprised 28 and 27 patients, respectively. Baseline demographics, lesion features, longitudinal length, and transverse width of resected specimens were comparable between stricture and non-stricture groups (all P > 0.05). Multivariate analysis revealed that a longitudinal length of circumferential involvement exceeding 50 mm was an independent risk factor (OR 9.10, 95% CI 2.27-33.30, P = 0.002), while SSPS demonstrated a significant protective effect compared with CST (OR 0.22, 95% CI 0.05-0.91, P = 0.036). Subgroup analysis showed that extensive circumferential involvement remained associated with stricture in the CST group (P = 0.012) but not in the SSPS group (P = 0.268). Of note, the subgroup analysis was limited by small sample size, and these findings should be considered preliminary. Total steroid exposure was not calculated but substantially lower in SSPS than in CST, supporting a favorable risk-benefit profile for SSPS.

A Longitudinal length of circumferential involvement exceeding 50 mm independently predicts post-cESD stricture, whereas SSPS provides superior protection compared to CST. These findings are preliminary and require validation in large-scale prospective studies. SSPS may potentially mitigate stricture risk in high-risk lesions, but its role in expanding cESD indications for extensive superficial esophageal cancer needs further exploration.