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

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.