Zhan SG, Wu BH, Li DF, Yao J, Xu ZL, Zhang DG, Shi RY, Tian YH, Wang LS. Oral higher dose prednisolone to prevent stenosis after endoscopic submucosal dissection for early esophageal cancer. World J Clin Cases 2022; 10(36): 13264-13273 [PMID: 36683621 DOI: 10.12998/wjcc.v10.i36.13264]
Corresponding Author of This Article
Li-Sheng Wang, PhD, Doctor, Department of Gastroenterology, Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, 1017 Dongmen North Road, Shenzhen 518020, Guangdong Province, China. wangls168@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2022; 10(36): 13264-13273 Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13264
Oral higher dose prednisolone to prevent stenosis after endoscopic submucosal dissection for early esophageal cancer
Sheng-Gang Zhan, Ben-Hua Wu, De-Feng Li, Jun Yao, Zheng-Lei Xu, Ding-Guo Zhang, Rui-Yue Shi, Yan-Hui Tian, Li-Sheng Wang
Sheng-Gang Zhan, Ben-Hua Wu, De-Feng Li, Jun Yao, Zheng-Lei Xu, Ding-Guo Zhang, Rui-Yue Shi, Yan-Hui Tian, Li-Sheng Wang, Department of Gastroenterology, Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China
Author contributions: Zhan SG and Wang LS were responsible for the design of the study and reviewed the manuscript; Zhan SG, Wu BH, Li DF, and Yao J extracted the data; Zhan SG, Xu ZL, Zhang DG, Shi RY, and Tian YH performed the data analysis; Zhan GS and Wang LS were responsible for revising the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital (Approval No. LL-KY-2022150-02).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Sheng Wang, PhD, Doctor, Department of Gastroenterology, Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, 1017 Dongmen North Road, Shenzhen 518020, Guangdong Province, China. wangls168@163.com
Received: August 28, 2022 Peer-review started: August 28, 2022 First decision: October 5, 2022 Revised: October 22, 2022 Accepted: December 5, 2022 Article in press: December 5, 2022 Published online: December 26, 2022
ARTICLE HIGHLIGHTS
Research background
Esophageal stenosis is one of the main complications of endoscopic submucosal dissection (ESD) for the treatment of large-area superficial esophageal squamous cell carcinoma and precancerous lesions (≥ 3/4 of the lumen). Oral prednisone is useful to prevent esophageal stenosis, but the curative effect remains controversial.
Research motivation
Explore more effective methods to prevent esophageal stenosis after ESD for early esophageal cancer and precancerous lesions.
Research objectives
We shared our experience of the precautions against esophageal stenosis after ESD to remove large superficial esophageal lesions.
Research methods
Patients with large superficial esophageal squamous cell carcinoma and high-grade intraepithelial neoplasia experienced ESD were enrolled. Prednisone (50 mg/d) was administered orally on the 2nd d after ESD for 1 mo, and tapered gradually (5 mg/wk) for 13 wk.
Research results
According to the range of esophageal mucosal defect, 11 cases involved ≥ 3/4 and < 7/8 circumference, 1 case involved ≥ 7/8 circumference, and 2 cases involved the entire circumference. The incidence of esophageal stenosis was 0% (0/14), and only 1 patient developed esophageal Candida infection on the 30th d after ESD and recovered completely after 7d of treatment with oral fluconazole 100 mg/d.
Research conclusions
Further investigation of larger samples is required to warrant feasibility and safety.
Research perspectives
In conclusion, increasing the dose of oral prednisone (50 mg/d) and prolonging the usage time (total 13 wk) may effectively prevent esophageal stenosis after ESD removing large-area superficial esophageal squamous cell carcinoma or precancerous lesions of esophagus, and does not increase the incidence of glucocorticoid-related adverse events.
