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Prophylactic use of steroids for a mucosal defect with a circumference of less than three-fourths prevents both symptomatic and asymptomatic stricture after esophageal endoscopic submucosal dissection

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Abstract

Background

Subclinical stricture after esophageal endoscopic submucosal dissection (ESD) makes the detection and re-ESD of metachronous lesions difficult. This study aimed to investigate the effectiveness of prophylactic steroid use after esophageal ESD for mucosal defects with a circumference less than 75% for the prevention of symptomatic and asymptomatic stricture.

Methods

In 80 retrospectively enrolled patients, we collected paired endoscopic images of a mucosal defects immediately after resection and a scar thereafter. After calculating circumference by image analysis software, all patients were classified into three groups in reference to mucosal defect circumference (MDC; ≤ 50%, 50–75%, ≥ 75%). Frequency of steroid use and symptomatic stricture were compared, and in < 75% MDC patients, a degree of asymptomatic stricture with or without steroid was compared by calculating a scar contraction rate (SCR).

Results

In the ≤ 50% (43 patients), 50–75% (27 patients) and ≥ 75% (10 patients) MDC groups, steroids were used in 12%, 59% and 100%, respectively, and symptomatic stricture occurred in 0%, 7% and 40%, respectively. In < 75% MDC patients, SCR in the steroid cohort was significantly lower than that in the nonsteroid cohort (42% vs. 65%, p = 0.002). No steroid-related adverse events occurred.

Conclusion

Steroid use even for mucosal defects with < 75% circumference appears effective for the reduction of the risk on both symptomatic and asymptomatic stricture after esophageal ESD.

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Authors and Affiliations

  1. Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan

    Eriko Koizumi, Tsugumi Habu, Osamu Goto, Shun Nakagome, Yumiko Ishikawa, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Teppei Akimoto, Jun Omori, Naohiko Akimoto & Katsuhiko Iwakiri

  2. Endoscopy Center, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan

    Osamu Goto

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  1. Eriko Koizumi
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  2. Tsugumi Habu
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Correspondence to Osamu Goto.

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Disclosures

Eriko Koizumi, Tsugumi Habu, Osamu Goto, Shun Nakagome, Yumiko Ishikawa, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Teppei Akimoto, Jun Omori, Naohiko Akimoto and Katsuhiko Iwakiri have no conflicts of interest or financial ties to disclose.

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Koizumi, E., Habu, T., Goto, O. et al. Prophylactic use of steroids for a mucosal defect with a circumference of less than three-fourths prevents both symptomatic and asymptomatic stricture after esophageal endoscopic submucosal dissection. Surg Endosc 37, 5875–5882 (2023). https://doi.org/10.1007/s00464-023-09988-7

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