Efficacy of steroid in prevention of esophageal strictures after endoscopic submucosal dissection for early esophageal cancer: A meta-analysis

Abstract

Objective To evaluate the efficacy of steroid in prevention of stricture after endoscopic submucosal resection(ESD) for early esophageal cancer. Methods Researches published in CBM, Pubmed, EMbase, the Cochrane Library database about the effect of steroid for prevention of stricture after ESD for early esophageal cancer were retrieved and screened.The expiration date for retrieval was in November 2017.RevMan5.3 software was used for the Meta-analysis. Results A total of 12 studies were included in the analysis, including 535 patients.The results of meta-analysis showed that local steroid injection could reduce the incidence of esophageal stricture (RR=0.41, 95%CI: 0.27-0.63, P<0.000 1). Oral steroid has no significant effect on reducing the incidence of esophageal stricture after circumferential ESD operation(RR=0.54, 95%CI: 0.16-1.84, P=0.33). It can reduce the incidence of esophageal stricture after semi-circumferential ESD surgery (RR=0.25, 95%CI: 0.11-0.54, P=0.0004). Both oral steroid (RR=-10.73, 95%CI: -15.47~-5.98, P<0.000 1) and local steroid injection (RR=-3.22, 95%CI: -5.11~-1.34, P=0.0008) can reduce required EBD sessions of esophageal stenosis. Conclusions Steroid for the prevention of stricture after ESD for early esophageal cancer is safe and effective; Oral steroid has no effect for the prevention of stricture after circumferential ESD, but can reduce stricture rate of semi-circumferential ESD for esophageal lesions; Both oral steroid and local steroid injection can reduce required EBD sessions for stricture.And for the effect of reducing required EBD sessions for stricture, oral steroid is better than that of local steroid injection. Key words: Steroid; Endoscopic submucosal dissection; Early esophageal cancer; Prevention of stricture