Are Steroids Effective in the Prevention of Esophageal Stenosis After Endoscopic Submucosal Dissection?

Background: Endoscopic submucosal dissection (ESD) is an effective endoscopic resection technique to remove gastrointestinal neoplasms. We aim to evaluate for efficacy outcomes of steroids in preventing postoperative esophageal stenosis (PES) after ESD. Methods: Major databases were systematically searched to retrieve studies comparing post-ESD outcomes after steroid administration versus control. Primary outcomes included PES rate, number of endoscopic balloon dilatation (EBD) sessions, and postoperative adverse events, categorized by administration route and steroid type. Secondary outcomes included subgroup analysis of PES rate and number of EBD sessions categorized by administration time after ESD. Results: Sixteen studies containing 1056 patients (mean age: 67.9±8.2 y old, 72.6% male) were included. Steroid administration significantly achieved a lower postoperative esophageal stenosis rate [odds ratio (OR): 0.36; 95% CI: 0.26-0.49] and required less EBD sessions [mean difference (MD), -1.20; 95% CI: -2.40 to -0.37] compared with control with no differences in postoperative adverse events comparing the 2 groups ( P =0.51). Subgroup analysis indicated that systemic steroids had significantly less required EBD sessions (MD: -2.31; 95% CI: -3.80 to -0.83) compared with local steroids (MD: -0.56; 95% CI: -1.60 to 0.48). In addition, prednisolone had significantly less required EBD sessions (MD: -1.15; 95% CI: -2.05 to -0.24) compared with triamcinolone (MD: -0.41; 95% CI: -1.27 to 0.44). Conclusions: Steroid administration after ESD is effective in reducing PES rate and EBD sessions without adverse events. Systemic steroids were superior to local steroids in reducing EBD sessions. The steroid route and administration time after ESD had no effect on outcomes.