Editorial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2025; 17(3): 101428
Published online Mar 16, 2025. doi: 10.4253/wjge.v17.i3.101428
Stricture prevention after circumferential endoscopic submucosal dissection of the esophagus: Proactive vs reactive strategies
Giulio Calabrese, Sandro Sferrazza, Daryl Ramai, Marcello Maida
Giulio Calabrese, Sandro Sferrazza, Department of Gastroenterology and Endoscopy, ARNAS Ospedali Civico-Di Cristina-Benfratelli, Palermo 90127, Sicilia, Italy
Daryl Ramai, Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, MA 02115, United States
Marcello Maida, Department of Medicine and Surgery, University of Enna “Kore,” Enna 94100, Sicilia, Italy
Author contributions: Calabrese G, Sferrazza S, Ramai D, and Maida M are the guarantors of the integrity of the entire study and contributed to the manuscript drafting and revision for important intellectual content.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marcello Maida, MD, Associate Professor, Department of Medicine and Surgery, University of Enna “Kore,” Via Cusmano, 1, Enna 94100, Sicilia, Italy. marcello.maida@unikore.it
Received: September 14, 2024
Revised: December 30, 2024
Accepted: February 10, 2025
Published online: March 16, 2025
Processing time: 181 Days and 10.5 Hours
Abstract

In this editorial, we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection. This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al. To this end, stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life. Therefore, we assess the efficacy of both reactive and proactive measures, ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques, including tissue engineering and polyglycolic acid sheet placement. However, no single treatment has shown high efficacy, particularly for resections involving the entire circumference. Despite these shortcomings, the combination of different strategies may improve patient outcomes, although further large-scale studies are needed for validation.

Keywords: Endoscopic submucosal dissection; Esophagus; Circumferential; Stenosis; Stricture

Core Tip: This editorial displayed the current strategies for preventing stenosis formation after circumferential esophageal endoscopic submucosal dissection. Use of a single reactive or proactive strategy has not been found to be highly effective, especially in resections involving the entire esophageal circumference. Combining two or more strategies represents a promising option to optimize patients’ quality of life and reduce symptoms. As a result, there is a pressing need for large prospective studies to further investigate this issue and ultimately determine the most effective strategy.