Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis

• Published in: Surgical endoscopy Vol. 30; no. 7; pp. 2779 - 2791
• Main Authors: Oliveira, J. F., Moura, E. G. H., Bernardo, W. M., Ide, E., Cheng, S., Sulbaran, M., Santos, C. M. L., Sakai, P.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2016; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma - surgery; Cancer; Carcinoma, Squamous Cell - surgery; Clinical trials; Dissection; Endoscopic Mucosal Resection - adverse effects; Endoscopic Mucosal Resection - methods; Endoscopy; Esophageal Neoplasms - surgery; Esophageal Stenosis - etiology; Esophageal Stenosis - prevention & control; Esophagoscopy - adverse effects; Esophagoscopy - methods; Esophagus; Gastroenterology; Gynecology; Hepatology; Humans; Literature reviews; Lymphatic system; Medicine; Medicine & Public Health; Meta-analysis; Observational studies; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Prevention; Proctology; Quality of Life; Surgery; Systematic review; Tumors; Brazil; Esophageal stenosis; Systematic review; Esophageal stricture; Endoscopy submucosal dissection; ESD; Meta-analysis
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-015-4551-9

Background Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review. Methods A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD. Results We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies, n  = 85), the preventive therapy decreased the risk of stenosis (risk difference = −0.36, 95 % CI −0.55 to −0.18, P  = 0.0001). Two studies (one randomized and one non-randomized, n  = 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = −8.57, 95 % CI −13.88 to −3.25, P  < 0.002). There were no significant differences in the three RCT studies ( n  = 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI −0.09 to 0.14, P  = 0.68). Conclusions The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.