Stent placement to prevent strictures after esophageal endoscopic submucosal dissection: a systematic review and meta-analysis

Author(s):  
Bao-zhen Zhang ◽  
Yue Zhang ◽  
Yi-dan Wang ◽  
Ye Liao ◽  
Jing-jing Zhang ◽  
...  

SUMMARY Endoscopic submucosal dissection (ESD) is an important method for the treatment of early esophageal cancer. However, post-procedure stenosis is one of the most common long-term complications. This meta-analysis aimed to investigate whether stent placement is effective in the stenosis prevention, and which type of stent would be more effective. A systematic and electronic search of clinical trials and observational studies conducted before March 2020 on the efficacy of stent placement in preventing esophageal stricture after ESD was performed. Search terms included “ESD,” “esophageal stenosis,” “esophageal stricture,” and “stents.” We conducted a bias risk assessment of the eligible reports and a meta-analysis of the data using Revman 5.3 software. We included two randomized controlled trials (RCTs) and a prospective cohort study involving 163 patients with esophageal mucosal defects encompassing at least three-quarters of the esophagus circumference after ESD. The meta-analysis results showed that post-ESD stenosis rates (RR, 0.37; 95% CI, 0.22–0.64; P = 0.0003) and the number of endoscopic balloon dilations (EBDs) (MD, −1.74; 95% CI, −2.46 to −1.01; P < 0.00001) were reduced in the pooled analysis of three studies, indicating that stent placement was effective for stenosis prevention, especially a polyglycolic acid (PGA) sheet combined with stent placement can prevent stenosis (RR, 0.41; 95% CI, 0.23–0.74; P = 0.003) and reduce the number of EBDs (MD, −1.65; 95% CI, −2.40 to −0.90; P < 0.0001) significantly. Stent placement can reduce the rate of esophageal stenosis after ESD, especially when stents are covered with PGA sheets. However, more high-quality, low-bias RCTs with a sufficient sample size are needed to demonstrate its effectiveness.

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Jing Wen ◽  
Zhongsheng Lu ◽  
Qingsen Liu

Endoscopic submucosal dissection (ESD) for the treatment of esophageal mucosal lesions is associated with a risk of esophageal stenosis, especially for near-circumferential or circumferential esophageal mucosal defects. Here, we review historic and modern studies on the prevention and treatment of esophageal stenosis after ESD. These methods include prevention via pharmacological treatment, endoscopic autologous cell transplantation, endoscopic esophageal dilatation, and stent placement. This short review will focus on direct prevention and treatment, which may help guide the way forward.


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