Zhou Shunhai, Chen Xuanran, Feng Mingzhi, Shi Chaoyi, ZhuoMa GeSang, Ying Lina, Zhang Zhenyu, Cui Liyang, Li Ruifang, Zhang Jun
The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
The Second School of Clinical Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
Gastrointest Endosc. 2024 Dec;100(6):1020-1033.e3. doi: 10.1016/j.gie.2024.08.017. Epub 2024 Aug 22.
Endoscopic submucosal dissection (ESD) is currently the standard therapy for superficial esophageal cancer (SEC). However, postoperative mucosal defects often lead to esophageal stricture. Although steroid application is effective prophylaxis, the efficacy and safety of various steroid administration modes remain unclear. Thus, this study aimed to evaluate the efficacy and safety of different steroid administrations for SEC patients after ESD.
A search for relevant studies was conducted on China National Knowledge Infrastructure, Wanfang Database, PubMed, Embase, and Web of Science up to March 25, 2024. Treatment strategies were categorized into 4 groups: no prevention as control (CON), steroid injection (SI), oral steroid (OS), and SI combined with OS (SI+OS). A comparative meta-analysis was conducted to assess outcomes, including postoperative esophageal stricture rate and the number of endoscopic balloon dilation (EBD) sessions required after stricture.
A total of 25 studies, involving 1555 patients, were included. The surface under the cumulative rankings were as follows: SI+OS (98.9%) > OS (59.9%) > SI (41.2%) > CON (0.0%) in preventing postoperative esophageal stricture, and OS (76.9%) > SI+OS (62.1%) > SI (61.0%) > CON (0.0%) in the number of EBD sessions required. Forest plot results indicated that compared with the nonsteroid group, steroid interventions were associated with lower rates of postoperative stricture and fewer EBD sessions. Additionally, SI+OS was superior to SI or OS alone in preventing stricture, with no significant differences observed between different steroid administrations in terms of EBD sessions. The incidence of adverse reactions was <10% for all interventions, mostly mild and resolvable upon discontinuation.
This study suggests that combined administration appears preferable for preventing esophageal stricture in patients after ESD and that steroids could enhance stricture prognosis. However, owing to the lack of large-sample randomized controlled trials comparing different steroid administrations, more high-quality research is necessary to confirm these findings in the future.
内镜黏膜下剥离术（ESD）是目前治疗浅表性食管癌（SEC）的标准疗法。然而，术后黏膜缺损常导致食管狭窄。尽管应用类固醇是有效的预防措施，但各种类固醇给药方式的疗效和安全性仍不明确。因此，本研究旨在评估不同类固醇给药方式对ESD术后SEC患者的疗效和安全性。
截至2024年3月25日，在中国知网、万方数据库、PubMed、Embase和Web of Science上检索相关研究。治疗策略分为4组：不进行预防作为对照组（CON）、类固醇注射（SI）、口服类固醇（OS）以及SI联合OS（SI+OS）。进行比较性荟萃分析以评估结局，包括术后食管狭窄率以及狭窄后所需的内镜下球囊扩张（EBD）次数。
共纳入25项研究，涉及1555例患者。累积排名下的面积如下：在预防术后食管狭窄方面，SI+OS（98.9%）>OS（59.9%）>SI（41.2%）>CON（0.0%）；在所需EBD次数方面，OS（76.9%）>SI+OS（62.1%）>SI（61.0%）>CON（0.0%）。森林图结果表明，与非类固醇组相比，类固醇干预与较低的术后狭窄率和较少的EBD次数相关。此外，SI+OS在预防狭窄方面优于单独的SI或OS，不同类固醇给药方式在EBD次数方面未观察到显著差异。所有干预措施的不良反应发生率均<10%，大多为轻度，停药后可缓解。
本研究表明，联合给药在预防ESD术后患者食管狭窄方面似乎更可取，且类固醇可改善狭窄预后。然而，由于缺乏比较不同类固醇给药方式的大样本随机对照试验，未来需要更多高质量研究来证实这些发现。
