S944 Efficacy of Prophylactic Stent Placement to Prevent Esophageal Stricture After Esophageal Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis

Introduction: Esophageal stricture is a major concern after endoscopic submucosal dissection (ESD) in patients with esophageal lesions. Different prophylactic methods to prevent stricture formation have been explored. In this meta-analysis, we have evaluated the efficacy of prophylactic fully covered metal stent placement to prevent esophageal strictures after esophageal ESD. Methods: We reviewed several databases from inception to May 10, 2025, to identify studies that evaluated the efficacy and safety of prophylactic esophageal stent placement to prevent esophageal strictures after ESD. Our outcomes of interest were rates of esophageal strictures and need for balloon dilation after esophageal stent placement. We also compared rates of stricture and mean number of balloon dilation sessions after stent alone vs polyglycolic acid (PGA) sheet + stent. We calculated pooled rates with 95% confidence intervals (CI) for our outcomes of interest. For comparatives outcomes, we calculated odds ratios (OR) (95% CI) for categorical data and mean difference (MD) (95% CI) for continuous data. Data was analyzed using a random effect model. Heterogeneity was assessed using I2 statistic. Results: We included 5 studies (2 randomized controlled trials and 3 observational) in the final analysis. The mean age of the patients was 64.5 (3.05) years. Pooled rates (95% CI) of esophageal stricture after prophylactic stent placement were 20.9% (13.8%, 30.8%; P = 0.48; I² = 0%. Comparative analysis of PGA + stent vs stent alone showed that PGA + stent was associated with lower rates of strictures, OR 0.41 (0.23, 0.74); P = 0.003; I² = 0%, and lower number of endoscopic balloon dilatation sessions, MD -1.65 (-2.40, 0.90); P < 0.0001; I² = 0%. Conclusion: Our meta-analysis demonstrates the efficacy of prophylactic esophageal stent placement to prevent esophageal strictures after ESD. PGA + stents were associated with lower rates of esophageal strictures compared to stents alone. More studies with larger sample sizes are needed to further evaluate these findings.