Prevention of esophageal strictures after endoscopic submucosal dissection

Table 1 Anti-inflammatory drugs for the prevention of esophageal strictures after endoscopic submucosal dissection

	Action	Administration	Advantages	Disadvantages and limitations
Clinical study
Corticosteroids	Steroidal	Oral intake	Strongly inhibits the infiltration of inflammatory cells, the hyperplasia associated with granulation, and the fibrosis of the remaining submucosal layer	General side effects (severe infection, peptic ulcer, hyperglycemia, psychiatric symptoms, and osteoporosis)
				Delayed wound healing
Triamcinolone acetonide	Steroidal	Local injection	Inhibits the infiltration of inflammatory cells, the hyperplasia associated with granulation, and the fibrosis of the remaining submucosal layer	Risk of ulcer formation due to accidental injection into the muscularis
				Delayed wound healing
Pre-clinical study
MMC	Inhibition of DNA synthesis	Local injection	Inhibits the proliferation and activation of fibroblasts	An effect has not been shown for the prevention of esophageal strictures, although MMC improves recurrent dysphagia or restenosis after the dilatation of esophageal strictures
				The risks of perforation and secondary malignancy
N-acetylcysteine	Antioxidant molecule	Oral intake	Antifibrotic effect without the inhibition of wound healing	Insufficient effect in an animal model of severe esophageal stricture

MMC: Mitomycin C.