Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2017; 23(6): 931-934
Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.931
Prophylactic stenting for esophageal stricture prevention after endoscopic submucosal dissection
Ke-Da Shi, Feng Ji
Ke-Da Shi, Feng Ji, Department of Gastroenterology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Shi KD and Ji F equally contributed to the analysis of the literature and writing of the manuscript.
Conflict-of-interest statement: Both authors declare no conflict of interest related to this publication.
Open-Access: 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/
Correspondence to: Feng Ji, MD, PhD, Deputy Director, Department of Gastroenterology, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Rd., Hangzhou 310000, Zhejiang Province, China. jifeng1126@sina.com
Telephone: +86-571-87236568 Fax: +86-571-87236568
Received: August 28, 2016
Peer-review started: September 1, 2016
First decision: September 20, 2016
Revised: October 6, 2016
Accepted: November 12, 2016
Article in press: November 13, 2016
Published online: February 14, 2017
Abstract

Endoscopic submucosal dissection (ESD) of superficial esophageal cancer has been increasingly used as an alternative to surgery because it is minimally invasive and has a high rate of en bloc resection. However, a high rate of esophageal stricture is observed after ESD for large lesions, which can dramatically decrease the patient’s quality of life. Stricture prevention is necessary to allow for endoscopic therapy to expand. We, herein, review the most recent evidence and discuss the role of the metallic self-expandable stent and the biodegradable stent in esophageal stricture prevention. Limited studies suggested that prophylactic stenting could reduce the stricture rate without increasing the number of complications. In addition, the number of bougie dilation procedures was significantly lower with stent placement. Esophageal stenting is a promising option for post-ESD stricture prevention. However, current evidence is too preliminary to formulate practice standards. Future studies are needed to further validate the efficacy and safety of prophylactic stenting and determine the best strategy for stricture prevention. Stent migration is the most common complication. A new stent that has advantages of a low migration rate and minimal tissue reaction will need to be developed. Therefore, randomized controlled trials with long-term follow-up periods are required before prophylactic stenting could be considered a valid option to prevent post-ESD stricture.

Keywords: Biodegradable stent, Stricture prevention, Esophageal stricture, Metallic self-expandable stent, Endoscopic submucosal dissection

Core tip: Esophageal stenting is a promising option for esophageal stricture prevention. Current evidence is too preliminary to formulate practice standards. Randomized controlled trials with long-term follow-up periods and cost-effective studies are required before prophylactic stenting could be considered a valid option to prevent post-endoscopic submucosal dissection stricture.