Prevention and Treatment of Esophageal Stenosis after Endoscopic Submucosal Dissection for Early Esophageal Cancer

Abstract

Endoscopic submucosal dissection (ESD) for the treatment of esophageal mucosal lesions is associated with a risk of esophageal stenosis, especially for near-circumferential or circumferential esophageal mucosal defects. Here, we review historic and modern studies on the prevention and treatment of esophageal stenosis after ESD. These methods include prevention via pharmacological treatment, endoscopic autologous cell transplantation, endoscopic esophageal dilatation, and stent placement. This short review will focus on direct prevention and treatment, which may help guide the way forward.

Systematic review: the prevention of oesophageal stricture after endoscopic resection

“…The anti‐inflammatory and anti‐fibrotic properties of steroids are partly explained by the inhibition of TGF‐ß1 expression and the induction of apoptosis in fibroblasts . Intralesional injections of triamcinolone—as routinely performed in the treatment of hypertrophic and keloid scars after dermatologic surgery, although with repeated treatment sessions—have been tested for the treatment of refractory oesophageal strictures .…”

“…Since there is no reason to believe that dilation may favour epithelial or submucosal healing, preventive EBD might actually be early and intensive curative EBD . Single‐session preventive EBD within 1 week of the resection has been reported as effective, but most authors recommend repeated treatment sessions starting 3 days to 1 week after the resection, and repeating treatment once or twice a week until healing of the wound without stricture, usually at 8 weeks . Compared to controls, preventive EBD significantly decreased the incidence of stricture from 92% to 59% ( P = 0.04) in a retrospective study that included 41 patients .…”

“…Most post‐endoscopic strictures are refractory and require numerous dilations . A clinical success rate of 71.4% at 6 months, which is comparable to the outcomes of peptic stricture dilation, has been reported after repeated endoscopic bougienage or hydrostatic dilation, but long‐term follow‐up data are lacking.…”

Topical hemostatic powder promotes reepithelialization and reduces scar formation after extensive esophageal mucosal resection

“…Different strategies to prevent post‐endoscopic stricture are being explored, such as topical application of anti‐proliferative agents, local or systemic corticosteroid therapy, and cell sheet therapy, and these methods have yielded variable results. Overall, due to safety concerns or high costs, these strategies are currently inadequate for broad clinical application . An alternative means to prevent post‐endoscopic stricture is to protect the submucosa and muscularis propria after the endoscopic resection using an adherent material on the wound to isolate it from physical, chemical, or microbial aggression, thus limiting inflammatory and fibrogenic processes in the esophageal wall .…”

Interventional Therapy of Esophageal Cancer

“…Patients' quality of life is seriously affected due to these complications. Currently, the methods of prevention and treatment of esophageal stenosis include endoscopic autologous cell transplantation, pharmacological treatment, stent placement and endoscopic esophageal dilatation [25]. However, no single method has been widely recognized as effective in clinical practice.…”