Department of Gastroenterology, ShengJing Hospital of China Medical University, Shenyang, China.
Dis Esophagus. 2021 Sep 9;34(9). doi: 10.1093/dote/doab015.
Endoscopic submucosal dissection (ESD) is an important method for the treatment of early esophageal cancer. However, post-procedure stenosis is one of the most common long-term complications. This meta-analysis aimed to investigate whether stent placement is effective in the stenosis prevention, and which type of stent would be more effective. A systematic and electronic search of clinical trials and observational studies conducted before March 2020 on the efficacy of stent placement in preventing esophageal stricture after ESD was performed. Search terms included "ESD," "esophageal stenosis," "esophageal stricture," and "stents." We conducted a bias risk assessment of the eligible reports and a meta-analysis of the data using Revman 5.3 software. We included two randomized controlled trials (RCTs) and a prospective cohort study involving 163 patients with esophageal mucosal defects encompassing at least three-quarters of the esophagus circumference after ESD. The meta-analysis results showed that post-ESD stenosis rates (RR, 0.37; 95% CI, 0.22-0.64; P = 0.0003) and the number of endoscopic balloon dilations (EBDs) (MD, -1.74; 95% CI, -2.46 to -1.01; P < 0.00001) were reduced in the pooled analysis of three studies, indicating that stent placement was effective for stenosis prevention, especially a polyglycolic acid (PGA) sheet combined with stent placement can prevent stenosis (RR, 0.41; 95% CI, 0.23-0.74; P = 0.003) and reduce the number of EBDs (MD, -1.65; 95% CI, -2.40 to -0.90; P < 0.0001) significantly. Stent placement can reduce the rate of esophageal stenosis after ESD, especially when stents are covered with PGA sheets. However, more high-quality, low-bias RCTs with a sufficient sample size are needed to demonstrate its effectiveness.
内镜黏膜下剥离术（ESD）是治疗早期食管癌的重要方法。然而，术后狭窄是最常见的长期并发症之一。本荟萃分析旨在探讨支架置入术预防狭窄的有效性，以及哪种类型的支架更为有效。系统检索了 2020 年 3 月前关于 ESD 后支架置入术预防食管狭窄疗效的临床试验和观察性研究，检索词包括“ESD”“食管狭窄”“食管狭窄”和“支架”。我们对合格报告进行了偏倚风险评估，并使用 RevMan 5.3 软件对数据进行了荟萃分析。我们纳入了两项随机对照试验（RCT）和一项前瞻性队列研究，共纳入了 163 例 ESD 后食管黏膜缺损至少占食管周长四分之三的患者。荟萃分析结果显示，支架置入术可降低 ESD 后狭窄发生率（RR，0.37；95%CI，0.22-0.64；P=0.0003）和内镜球囊扩张术（EBD）次数（MD，-1.74；95%CI，-2.46 至-1.01；P<0.00001），表明支架置入术可有效预防狭窄，特别是聚乙醇酸（PGA）片联合支架置入术可预防狭窄（RR，0.41；95%CI，0.23-0.74；P=0.003）和减少 EBD 次数（MD，-1.65；95%CI，-2.40 至-0.90；P<0.0001）。支架置入术可降低 ESD 后食管狭窄发生率，特别是支架覆盖 PGA 片时。然而，需要更多高质量、低偏倚、样本量大的 RCT 来证明其有效性。
