Useful strategies to prevent severe stricture after endoscopic submucosal dissection for superficial esophageal neoplasm

Table 1 Risk factors of esophageal stricture formation after endo-therapy

Ref.	Setting	Study design	Patients (n)	Mechanical stenosis and/or symptom(dysphasia)	Risk factor	Additional therapy of chemo/radiation	Follow-up period (mo)
Ono et al[15]	Single center	Retrospective	65	Necessity of EBD	More than three-fourths of circumferential extension of mucosal defect (OR = 44.2; 95%CI: 4.4-443.6) histologic depth to the LPM cancer (OR = 14.2; 95%CI: 2.7-74.2)	Excluded	Unknown
Shi et al[26]	Single center	Retrospective	362	Failure to pass a standard endoscope (11 mm-diameter)	More than three-fourths of circumferential extension of mucosal defect (OR = 44.2, 95%CI: 4.4-443.6) depth of invasion above the LPM cancer (OR = 14.2, 95%CI: 2.7-74.2)	Excluded	41 (16-77)
Takahashi et al[25]	Single center	Retrospective	76	Failure of both symptomatic relief of dysphagia and the passage of a standard endoscope (9.2 mm or 9.0 mm-diameter) without any resistance 4-wk after the last session	More than three-fourths of the circumferential extent of mucosal defect (OR = 305.9; 95%CI: 89.387-1046.8)	Excluded	Stricture group: 30.0 (5-142) nonstricture group: 45.0 (6-174)

EBD: Endoscopic balloon dilation.

Table 2 Results of previous studies on preventive strategies for esophageal stricture after endo-therapy

Ref.			Subjects				Stenosis			Dilation therapy		Outcome
	Preventive strategy	Study design	n	Tumor stage	Circumference of the mucosal defect	Additional therapy of chemo/radiation	Difinition of stenosis	Dysphasia (symptom)	Dysphasia score	Indication	Device	Follow-up period	Stenosis rate	Therapeutic ED number
Ezoe et al[41]	Preventive EBD	Case series, retrospective	41	T1a-T1b	Subcircumference (> 3/4) -circumference	Excluded	No passage of an endoscope (Φ11 mm)	Complaint of dysphagia	-	Mechanical/symptomatic	CRE balloon (four size)	Median 84 mo	59%	4.5 (0-35)
Uno et al[29]	Preventive EBD + tranilast	Case-control, prospective	31	T1a-T1b (SM1)	Subcircumference (> 3/4) -circumference of the lesion	Excluded	Vomiting at least once a week + no passage of an endoscope (Φ10.8 mm)	Dysphagia to regular solid meal	+	Mechanical + symptomatic	CRE balloon (15-18 mm)	24.3 ± 7.4 mo	33.30%	0.0 (0.0-1.75)
Wen et al[61]	Fully covered metalic stent	Cohort study, prospective	22	T1a-T1b (SM1)	Subcircumference (> 3/4) -circumference	Excluded	No passage of an endoscope (Φ9.8 mm)	Persistent dysphagia to regular solid meal	-	Mechanical	Savary-Gilliard dilator	12 wk	18.20%	0.45 (0-3)
Hashimoto et al[71]	Local injection of steroid	Case-control, retrospective	41	T1a-T1b (SM3)	Subcircumference (> 3/4)	Included	Complaint of dysphasia/no passage of an endoscope (Φ11.4 mm)	Complaint of dysphagia	-	Mechanical	CRE balloon (unclear)	Unclear	19.00%	1.7 (0-15)
Hanaoka et al[72]	Local injection of steroid	Cohort study, prospective	59	T1a-T1b	Subcircumference (> 3/4)	Included (chemotherapy)	Dysphagia to some solids/no passage of an endoscope (Φ9.2 mm)	Dysphagia to some solids	+	Symptomatic	Unclear	8 wk	10%	0 (0-2)
Yamaguchi et al[65]	Systemic administration of steroid	Cohort study, retrospective	41	T1a-T1b (SM1)	Subcircumference (> 3/4) -circumference	Excluded	Unclear	Complaint of dysphagia	-	Symptomatic	CRE balloon (15-18 mm)	3 mo	5.30%
												6-12 mo		1.7 (0-7)
Sato et al[77]	Systemic administration of steroid + EBD	Cohort study, retrospective	23	T1a-T1b (SM3)	Circumference	Included	Resistence/failure to pass an endoscope (Φ9.9 mm)	-	-	Mechanical	CRE baloon (15-18 mm)	No fininition	-	13.8 ± 6.9
Ohki et al[98]	Autologous oral mucosal epithelial cell sheets	Single-arm	9	Unknown	Subcircumference (> 2/3)	Unknown	No definition	-	+	Mechanical	Unclear	-	-	2.33 (0-21)
Sakaguchi et al[106]	PGA	Case series, prospective	8	T1a-T1b (SM2)	Subcircumference (> 3/4)	Unknown	Failure to pass a endoscope (Φ9.8 mm)	Symptoms of dysphasia	-	Mechanical	CRE balloon (12-18 mm)	No definition	37.5 % (about 28 POD)	0.8 ± 1.2
Iizuka et al[107]	PGA	Case series, prospective	15	T1a-T1b (SM2)	Subcircumference (> 1/2)	Excluded	Unclear	Unclear	-	Unclear	EBD (unclear)	6 wk	7.70%	5

PGA: Polyglycolic acid; ESD: Endoscopic submucosal dissection; EBD: Endoscopic balloon dilation.