Table 2.
Comparative studies of steroid therapy in the prevention of stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma, mainly compared with no therapy or prophylactic endoscopic balloon dilation.
| Author | Year | Study Design | Protocol Therapy | Mucosal Deffect Circumference |
Case Numbers (Protocol: Control) |
Incidence of Stricture (Protocol vs. Control) |
p-Value *1 |
|---|---|---|---|---|---|---|---|
| Hashimoto [21] | 2011 | Retrospective, historical control |
TA injection | >3/4 | 21:20 (untreated) |
19% vs. 75% | <0.001 |
| Yamaguchi [16] *2 | 2011 | Retrospective, historical control |
Oral PSL for eight weeks | >3/4 | 19:22 (prophylactic EBD) *3 |
5.3% vs. 31.8% | 0.03 |
| Isomoto [22] *2 | 2011 | Retrospective, historical control |
Oral PSL for eight weeks | Total circumference |
4:3 (prophylactic EBD) |
50% vs. 100% | N.S. |
| Hanaoka [23] | 2012 | Prospective, historical control |
TA injection | >3/4 | 30:29 (untreated) |
10% vs. 66% | <0.001 |
| Takahashi [24] | 2012 | Prospective, randomized |
TA injection | Lesion > 2/3 | 16:16 (untreated) *4 |
62.5% vs. 87.5% | 0.22 |
| Sato [25] | 2013 | Prospective, historical control |
Oral PSL for eight weeks + prophylactic EBD |
Total circumference |
10:13 (prophylactic EBD) *5 |
100% vs. 100% | N.S. |
| Mori [26] | 2013 | Prospective, randomized |
① TA gel + prophylactic EBD ② TA injection + prophylactic EBD |
>2/3 | 20:21 (①:②) |
N/A *6 | N/A |
| Kadota [27] | 2016 | Retrospective | ① TA injection + Oral PSL for eight weeks ② TA injection |
>3/4 | 29:53:33 (①:②: untreated) |
41% vs. 43% Vs. 67% (①:②: untreated) |
0.073 (① vs. untreated) 0.046 (② vs. untreated) |
| Nagami [28] | 2017 | Retrospective, matched |
TA injection | >2/3 | 37:37 (untreated) |
18.9% vs. 45.9% | 0.016 |
| Zhou [29] | 2017 | Retrospective | Oral PSL for 12 weeks | >3/4 *7 | 13:10 (untreated) |
23.1% vs. 80% | <0.05 |
| Iizuka [30] | 2018 | Retrospective, historical control |
① Oral PSL for 18 weeks (±TA injection) *8 ② Oral PSL for eight weeks (±TA injection) *8 |
Total circumference |
11:11 (①:②) |
36.4% vs. 82% | 0.04 |
| Chu [31] | 2019 | Retrospective | TA injection + Oral PSL for eight weeks | >2/3 | 34:36 (untreated) |
14.7% vs. 52.8% | 0.001 |
| Pih [32] | 2019 | Retrospective | ① Oral PSL ② TA injection |
>3/4 | 25:6:22 (①: ②: untreated) |
20% vs. 33.3% vs. 50% (①:②: untreated) |
0.037 (① vs. untreated) 0.046 (①+② vs. untreated) |
TA, triamcinolone acetate; PSL, prednisolone; EBD, endoscopic balloon dilation; N/A, not available; NS, not significant. *1: p-values are presented as described in the literature. *2: Yamaguchi and Isomoto belong to the same institution. *3: Among them, three cases have the total circumferential mucosal defect. *4: Among them, 11 cases have mucosal defect circumference > 3/4. *5: Among them, one case of protocol therapy was adenocarcinoma. *6: The definition of stricture rate is different from that reported in other literature. *7: Among them, two cases have the total circumferential mucosal defect. *8: TA injections were performed in 10 cases in Group 1 and six cases in Group 2.