Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13264
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
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.
To share our experience of the precautions against esophageal stenosis after ESD to remove large superficial esophageal lesions.
Between June 2019 and March 2022, we enrolled patients with large superficial esophageal squamous cell carcinoma and high-grade intraepithelial neoplasia experienced who underwent ESD. Prednisone (50 mg/d) was administered orally on the second morning after ESD for 1 mo, and tapered gradually (5 mg/wk) for 13 wk.
In total, 14 patients met the inclusion criteria. All patients received ESD without operation-related bleeding or perforation. There were 11 patients with ≥ 3/4 and < 7/8 of lumen mucosal defects and 1 patient with ≥ 7/8 of lumen mucosal defect and 2 patients with the entire circumferential mucosal defects due to ESD. The longitudinal extension of the esophageal mucosal defect was < 50 mm in 3 patients and ≥ 50 mm in 11 patients. The esophageal stenosis rate after ESD was 0% (0/14). One patient developed esophageal candida infection on the 30th d after ESD, and completely recovered after 7 d of administration of oral fluconazole 100 mg/d. No other adverse events of oral steroids were found.
Oral prednisone (50 mg/d) and prolonged prednisone usage time may effectively prevent esophageal stricture after ESD without increasing the incidence of glucocorticoid-related adverse events. However, further investigation of larger samples is required to warrant feasibility and safety.
Core Tip: Esophageal stenosis is one of the main complications of endoscopic submucosal dissection (ESD) for the remedy of large-area superficial esophageal squamous cell carcinoma and precancerous lesions (≥ 3/4 of the lumen). Oral prednisone (30 mg/d) is one of the most commonly used treatment measures to prevent postoperative stenosis after esophageal ESD; however, several studies have drawn inconsistent conclusions. For the first time, we took a higher dose of prednisone (50 mg/d) orally to prevent esophageal stenosis after esophageal ESD and no stenosis occurred in 14 patients, meanwhile, no significant glucocorticoid-related adverse events occurred.