Work

Predictors of post-endoscopic submucosal dissection stricture in superficial esophageal cancer patients receiving oral steroid prophylaxis

Year: 2025

Type: article

Abstract: Identify risk factors for esophageal stricture persisting despite standard oral steroid prophylaxis after endoscopic submucosal dissection (ESD) for large-area superficial esophageal cancer.Methods: Retrospective analysis of 202 patients undergoing ESD (≥ 2/3 circumferential resection) with postoperative oral steroids. Patients were stratified by stricture occurrence. Univariate and multivariate logistic regression evaluated lesion/ESD-related risk factors. Refractory stricture (RS; requiring ≥ 5 endoscopic dilations) and non-refractory stricture (NRS) groups were compared for endoscopic balloon/bougie dilation (EBD) continuation rates.Results: The overall stricture rate was 35.2% (71/202). Multivariate analysis identified four independent risk factors: longitudinal diameter ≥ 5 cm (OR 3.06, 95%CI 1.38–6.80), circumferential involvement > 4/5 (OR 6.41, 95%CI 2.79–14.67), entire circumferential involvement (OR 54.91, 95%CI 11.02-273.68), and muscular injury (OR 21.89, 95%CI 4.04-118.58). EBD continuing rates at 1 year were 70% (RS) vs.22.9% (NRS); at 3 years, rates decreased to 20% (RS) and 2.1% (NRS). RS showed significantly higher EBD continuation (Chi-square 8.404, P = 0.004).Conclusion: In patients with large superficial esophageal cancers involving ≥ 2/3 circumference who receive oral steroid prophylaxis, circumferential involvement ≥ 4/5 or entire circumferential involvement, longitudinal lesions ≥ 5 cm, and muscular injury independently predict steroid-resistant strictures post-ESD. High-risk patients require cautious ESD planning and novel stricture prevention strategies. RS necessitates prolonged EBD management, reflecting poorer therapeutic response.

Source: Scientific Reports

DOI: 10.1038/s41598-025-23636-1