Prevention of Stricture after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer: A Review of the Literature

Abstract

Endoscopic resection has been the standard treatment for intramucosal esophageal cancers (ECs) because of the low risk of lymph node metastases in the lesions. In recent years, endoscopic submucosal dissection (ESD), which can resect large ECs, has been performed. However, the risk of esophageal stricture after ESD is high when the mucosal defect caused by the treatment exceeds 3/4 of the circumference of the lumen. Despite the subsequent high risk of luminal stricture, ESD has been performed even in cases of circumferential EC. In such cases, it is necessary to take measures to prevent stricture. Therefore, in this review, we aimed to clarify the current status of stricture prevention methods after esophageal ESD based on previous literature. Although various prophylactic methods have been reported to have stricture-preventing effects, steroid injection therapy and oral steroid administration are mainstream. However, in cases of circumferential EC, both steroid injection therapy and oral steroid administration cannot effectively prevent luminal stricture. To solve this issue, clinical applications, such as tissue shielding methods with polyglycolic acid sheet, autologous oral mucosal epithelial sheet transplantation, and stent placement, have been developed. However, effective prophylaxis of post-ESD mucosal defects of the esophagus is still unclear. Therefore, further studies in this research field are needed.

CSTA: A Biomarker Regulating Esophageal Stricture Epithelial Barrier, Potential Medication Target

“…Glucocorticoids have emerged as a highly effective approach for treating or alleviating esophageal strictures. While some patients experience relief from esophageal stricture with glucocorticoids, others may exhibit resistance to their effects, and the underlying cause for this insensitivity remains unclear (Hsu et al , 2023; Sakaguchi et al , 2023; Koizumi et al , 2023; Hikichi et al , 2020).…”

Advances in the application of regenerative medicine in prevention of post-endoscopic submucosal dissection for esophageal stenosis

“…Although numerous attempts have been made to solve the problem permanently, [ 61 , 62 , 63 , 64 , 65 , 66 ] none of them is perfectly effective. [ 67 ]…”

The effects of oral steroid duration on stricture prevention after extensive endoscopic submucosal dissection for superficial esophageal cancer

“…Esophageal ESD is a minimally invasive procedure associated with early recovery, a short hospital stay, improvement in the quality of life, and low complications in patients with SEC (1). However, esophageal stricture is a major complication of ESD that leads to dysphagia and aspiration pneumonia, ultimately affecting the patient's quality of life (2,17). The incidence of post-ESD esophageal stricture is reported as 6.5-16.7%, with an incidence of 45.5-92% if more than 75% of the esophageal circumference is resected (4,5).…”

“…Endoscopic submucosal dissection (ESD) is a minimallyinvasive procedure that improves the quality of life for patients with superficial esophageal cancer (SEC) by promoting early recovery and requiring a short hospital stay (1,2). However, the procedure results in esophageal stricture in 6.5-16.7% of patients (3,4).…”

“…However, the procedure results in esophageal stricture in 6.5-16.7% of patients (3,4). The incidence of esophageal stricture increases to 45-92% if more than 75% of the esophageal circumference is resected; therefore, various methods have been studied to prevent stricture (2,(5)(6)(7), including prophylactic oral steroid therapy. Prophylactic oral steroid therapy has been proven to be effective and is currently used for the prevention of esophageal stricture in patients who undergo resection of more than 75% of the esophagus circumference (8,9).…”