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Comparison of statins with steroids and botulinum toxin A in the prevention of benign strictures after esophageal endoscopic submucosal dissection: a retrospective cohort study

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Abstract

Background

Preventing benign strictures following esophageal endoscopic submucosal dissection (ESD) remains difficult, and finding a safe, effective, and simple management method is vital. We previously reported that rosuvastatin significantly reduced the incidence and severity of strictures in a rabbit model of esophageal stricture. Accordingly, in this study, we compared the effects of statins, steroids, and botulinum toxin A (BTX-A) on stricture prevention after ESD involving more than three-fourths of the luminal circumference.

Methods

Of the 1019 ESD cases treated between January 2015 and December 2020, 246 met the inclusion criteria, with 21 cases excluded due to loss to follow-up, tumor recurrence, death, or need for additional surgery, radiotherapy, and/or chemotherapy. Of the 225 included cases, 145 received no intervention, while the remaining 80 were treated: 16 with oral steroids, 20 with topical triamcinolone acetonide (TA) injection, 21 with topical BTX-A injection, and 23 with statins.

Results

The occurrence stricture rate in the statins group (17.4%, 4/23) was significantly lower than in the non-intervention (75.2%, 109/145, P = 0.000), oral steroids (56.3%, 9/16, P = 0.011) and TA injection (50%, 10/20, P = 0.023) groups, but comparable to in the BTX-A injection (38.1%, 8/21, P = 0.124) group. The dysphagia score was lower in the statin than non-intervention group (P = 0.000). Although there was no significant difference in the number of required dilations between groups, the maximum number of dilations in the statins group was only six.

Conclusions

Statins may be a potential treatment to prevent esophageal strictures after extensive ESD; however, clinical trials should be conducted to validate this.

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Acknowledgements

The authors would like thank all those who participated in this research.

Funding

This work was supported by grants from the National Natural Science Foundation of China (Research Grant 81900237, 82000623), and General Program of Clinical Ability Promotion Project of the First Affiliated Hospital of Nanjing Medical University (JSPH-MB-2021–13, JSPH-MB-2022-5). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Yanjuan Wang and Weiyu Xia have contributed equally to this paper.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China

    Yanjuan Wang, Weiyu Xia, Li Tian, Meihong Chen, Xinmin Si & Yaoyao Gong

  2. Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 of Hanzhong Road, Nanjing, 210029, China

    Boqian Zhu

  3. Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Shengli Lin

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  1. Yanjuan Wang
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Contributions

YG, BZ, YW, and SL were involved in the study design. All authors were involved in the implementation of the study. YW and MC conducted medical record data collection and telephone follow-up. YG, XS and SL reviewed ESD procedure records and pictures, and screened out patients with mucosal resection of more than three-quarters of the circumference. BZ, LT, and SL performed statistical analysis. YG, SL and WX wrote the manuscript. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Shengli Lin or Yaoyao Gong.

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Disclosures

Drs. Yanjuan Wang, Weiyu Xia, Li Tian, Boqian Zhu, Meihong Chen, Xinmin Si, Shengli Lin, and Yaoyao Gong have no conflicts of interests or financial ties to disclose.

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Wang, Y., Xia, W., Tian, L. et al. Comparison of statins with steroids and botulinum toxin A in the prevention of benign strictures after esophageal endoscopic submucosal dissection: a retrospective cohort study. Surg Endosc 37, 4328–4337 (2023). https://doi.org/10.1007/s00464-023-09906-x

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