Abstract
Background and AimsEndoscopic submucosal dissection (ESD) is the standard therapy for superficial esophageal cancer (SEC) presently. 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 post-ESD. MethodsA 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 four groups: no prevention as control (CON), steroid injection (SI), oral steroids (OS), and SI combined with OS (SI+OS). Comparative meta-analysis was conducted to assess outcomes, including postoperative esophageal stricture rate and the number of endoscopic balloon dilatation (EBD) sessions required after stricture. ResultsA total of 25 studies, involving 1555 patients, were included. The SUCRA rankings were as follows: SI+OS (98.9%) > OS (59.9%) > SI (41.2%) > CON (0.0%) in preventing postoperative esophageal stricture rate, 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 non-steroid 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 less than 10% for all interventions, mostly mild and resolvable upon discontinuation. ConclusionThis study suggests that combined administration appears preferable for preventing esophageal stricture in patients post-ESD, and steroids could enhance stricture prognosis. However, due to the lack of large-sample RCT studies comparing different steroid administrations, more high-quality research is necessary to confirm these findings in the future.
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