Oral steroid prophylaxis is effective in preventing esophageal strictures after large endoscopic resection

This item is provided by the institution :

Repository :
Annals of Gastroenterology
see the original item page
in the repository's web site and access all digital files if the item*

2016 (EN)
Oral steroid prophylaxis is effective in preventing esophageal strictures after large endoscopic resection (EN)

Pesenti, Christian
De Cassan, Chiara
Giovannini, Marc
Caillol, Fabrice
Poizat, Flora
Godat, Sebastien
Bories, Erwan
Ratone, Jean-Philippe

Background Strictures are frequent complications of large endoscopic mucosal resections (EMR) and endoscopic submucosal dissections of the esophagus. Local or systemic steroid therapy has shown promise in the prevention of secondary stenosis. The aim of this study was to evaluate the safety and efficacy of systemic steroid therapy following endoscopic resection of at least hemicircumferential esophageal mucosa.Methods This was a single-center retrospective study in a tertiary center. We evaluated patients who were treated with oral steroids between July 2013 and September 2015, after undergoing a large EMR for Barrett's esophagus associated with dysplasia or carcinoma. The steroid protocol used was an initial dose of 30 mg prednisolone, tapered over 8 weeks. Exclusion criteria were a previous attempt at radiofrequency ablation or resection.Results Thirty-one patients (27 men) were analyzed: 13 with low-grade dysplasia Barrett's esophagus, 16 with in situ adenocarcinoma, 1 with pT1SM1 adenocarcinoma, and 1 with pT1SM2 adenocarcinoma. Twenty-eight resections (28/31) were completed (R0) in 1-3 sessions (median 2), while 3 resections were R1. The median length of Barrett's esophagus was C3M5 (range C0M2-C10M11) according to the Prague classification. The median follow up was 10 months (range 4-17), during which 4 patients (13%) developed a secondary stenosis. All stenoses were successfully treated by endoscopic dilation (range 1-4). No complications related to dilation or to the steroid therapy were observed.Conclusions Our rate of secondary stricture was lower than expected, given the rates of 17-88% in published studies. Systemic oral steroid therapy seems to be effective in reducing potential esophageal stenosis after EMR. Complementary randomized studies are required to confirm whether systemic steroids are an effective primary prophylaxis for esophageal stenosis.Keywords Esophagus, endoscopic mucosal resection, esophageal strictures, oral steroid therapy, Barrett's esophagusAnn Gastroenterol 2017; 30 (1): 62-66 (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 30, No 1 (2017); 62 (EN)

*Institutions are responsible for keeping their URLs functional (digital file, item page in repository site)