title: Oral steroid prophylaxis is effective in preventing esophageal strictures after large endoscopic resection.
abstract: BACKGROUND
  Strictures are frequent complications of large endoscopic mucosal resections (EMR) and endoscopic submucosal dissections of the esophagus. Local or systemic steroid therapy has shown promise in the prevention of secondary stenosis. The aim of this study was to evaluate the safety and efficacy of systemic steroid therapy following endoscopic resection of at least hemi-circumferential esophageal mucosa.
  
  
  METHODS
  This was a single-center retrospective study in a tertiary center. We evaluated patients who were treated with oral steroids between July 2013 and September 2015, after undergoing a large EMR for Barrett's esophagus associated with dysplasia or carcinoma. The steroid protocol used was an initial dose of 30 mg prednisolone, tapered over 8 weeks. Exclusion criteria were a previous attempt at radiofrequency ablation or resection.
  
  
  RESULTS
  Thirty-one patients (27 men) were analyzed: 13 with low-grade dysplasia Barrett's esophagus, 16 with in situ adenocarcinoma, 1 with pT1SM1 adenocarcinoma, and 1 with pT1SM2 adenocarcinoma. Twenty-eight resections (28/31) were completed (R0) in 1-3 sessions (median 2), while 3 resections were R1. The median length of Barrett's esophagus was C3M5 (range C0M2-C10M11) according to the Prague classification. The median follow up was 10 months (range 4-17), during which 4 patients (13%) developed a secondary stenosis. All stenoses were successfully treated by endoscopic dilation (range 1-4). No complications related to dilation or to the steroid therapy were observed.
  
  
  CONCLUSIONS
  Our rate of secondary stricture was lower than expected, given the rates of 17-88% in published studies. Systemic oral steroid therapy seems to be effective in reducing potential esophageal stenosis after EMR. Complementary randomized studies are required to confirm whether systemic steroids are an effective primary prophylaxis for esophageal stenosis.
authors.affiliation: Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini).
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Ratone
authors.affiliation: Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini).
authors.forename: Erwan
authors.initials: E
authors.lastname: Bories
authors.affiliation: Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini).
authors.forename: Fabrice
authors.initials: F
authors.lastname: Caillol
authors.affiliation: Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini).
authors.forename: Christian
authors.initials: C
authors.lastname: Pesenti
authors.affiliation: Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini).
authors.forename: Sebastien
authors.initials: S
authors.lastname: Godat
authors.affiliation: Pathology Unit (Flora Poizat), Paoli-Calmettes Institute, Marseille, France.
authors.forename: Flora
authors.initials: F
authors.lastname: Poizat
authors.affiliation: Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini).
authors.forename: Chiara De
authors.initials: C
authors.lastname: Cassan
authors.affiliation: Endoscopy Unit (Jean-Philippe Ratone, Erwan Bories, Fabrice Caillol, Christian Pesenti, Sebastien Godat, Chiara De Cassan, Marc Giovannini).
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
keywords: Barrett’s esophagus; Esophagus; endoscopic mucosal resection; esophageal strictures; oral steroid therapy