Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis.
Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review.



A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD.



We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies, n = 85), the preventive therapy decreased the risk of stenosis (risk difference = -0.36, 95 % CI -0.55 to -0.18, P = 0.0001). Two studies (one randomized and one non-randomized, n = 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = -8.57, 95 % CI -13.88 to -3.25, P < 0.002). There were no significant differences in the three RCT studies (n = 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI -0.09 to 0.14, P = 0.68).



The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.
Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil. jfoliveira1@gmail.com.
J F
JF
Oliveira
Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil.
E G H
EG
Moura
Brazilian Medical Association (AMB), São Paulo, Brazil.|Medicine Federal Council (CFM), São Paulo, Brazil.
W M
WM
Bernardo
Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil.
E
E
Ide
Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil.
S
S
Cheng
Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil.
M
M
Sulbaran
Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil.
C M L
CM
Santos
Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil.
P
P
Sakai
D000230:Adenocarcinoma / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000517:prevention & control*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011788:Quality of Life
ESD; Endoscopy submucosal dissection; Esophageal stenosis; Esophageal stricture; Meta-analysis; Systematic review