Abstract:

Objective To compare and analyze the effects of different courses and reduction methods of glucocorticoids on preventing esophageal stenosis after endoscopic submucosal dissection (ESD). Methods A total of 67 patients who underwent ESD surgery for early esophageal cancer and precancerous lesions and orally medicated with glucocorticoids postoperatively to prevent esophageal stricture in our department from January 2017 to January 2023 were retrospectively included. According to the postoperative oral corticosteroids, patients were divided into the 3-week group, 8-week group, and 12-week group. Esophageal stricture, number of balloon dilations after stricture, and hormone-related complications were compared among the three groups. Results The esophageal stricture rate after ESD in the 3-week group, 8-week group, and 12-week group was 23.8%(5/21), 22.9%(8/35), and 18.2%(2/11), respectively, without a significant difference (P>0.05). The average number of endoscopic balloon dilations after stenosis in the 3-week group, 8-week group, and 12-week group was (2.80±0.84) times, (2.25±0.71) times and (2.50±0.71) times, respectively, without a significant difference (P>0.05). The incidence of hormone-related adverse reactions was 0, 5.7%(2/35), and 27.3%(3/11), respectively, without a significant difference (P>0.05). There was a significant difference in the incidence of hormone-related adverse reactions between the 3-week group and the 12-week group (P=0.012), and that between the 8-week group and the 12-week group (P=0.045).Conclusion Oral glucocorticoids can prevent esophageal stenosis after extensive ESD. Three-week therapy, eight-week therapy and twelve-week therapy have similar effects in the prevention of stenosis and the number of balloon dilatation after stenosis. However, short-term and low-dose hormone use has the least adverse reactions and high safety.

Key words: esophageal stenosis, glucocorticoid, endoscopic submucosal dissection, esophageal neoplasms, endoscopic treatment