Topical budesonide for stricture prevention following wide-field endoscopic submucosal dissection of superficial esophageal neoplasia

Introduction: Esophageal stricture (ES) is a frequent and clinically significant adverse event after wide-field endoscopic submucosal dissection (ESD) for superficial esophageal neoplasia. Despite multiple prophylactic strategies, prevention remains challenging, and current steroid-based regimens offer limited efficacy. This study evaluated the efficacy and safety of budesonide orodispersible tablets (BOT) for ES prevention after wide-field ESD. Methods: This retrospective, dual-center study evaluated prospectively collected data from patients with superficial esophageal neoplasia undergoing wide-field ESD (≥50% circumferential extent) between August 2020 and August 2024. All patients received BOT (Jorveza® 1 mg twice daily; Dr. Falk Pharma GmbH, Germany) for 4–8 weeks post-ESD. Patients receiving additional stricture-prevention measures were excluded. The primary endpoint was post-ESD stricture. Secondary endpoints included BOT-related adverse events. Results: Twenty patients (mean age 62.8 ± 10.8 years) underwent ESD with BOT prophylaxis. ES occurred in 35.0% overall – 13.3% after resections involving 50–90% of the esophageal circumference and 100% after circumferential (100%) resections. Patients with strictures had greater circumferential resection extent (85.7% vs. 59.2%; p = 0.036). Four strictures were mild (≤ 7 dilations) and three refractory (≥ 8). BOT was well tolerated; two patients (10.0%) developed asymptomatic esophageal candidiasis, and no systemic steroid-related adverse events occurred. Conclusion: BOT prophylaxis was well tolerated and may reduce strictures after non-circumferential resections; however, its protective effect appears limited in circumferential resections. Combination strategies may be warranted in high-risk patients.