Steroids or stenting for stricture prevention after endoscopic submucosal dissection: A systematic review and meta-analysis of randomized controlled trials
Notice bibliographique
Résumé
Aims Endoscopic submucosal dissection (ESD) is used for the resection of complex premalignant lesions and early esophageal neoplasms. With ESD, large defect sizes can result in symptomatic esophageal strictures post-resection. While there is currently no consensus on post-ESD stricture prophylaxis, steroids and esophageal stents are two of the most extensively studied prophylactic therapies. This study aims to compare the effectiveness and safety of steroids with stent placement for post-ESD esophageal stricture prophylaxis. Methods A literature search of OVID MEDLINE All from inception to October 2024 identified randomized controlled trials (RCTs) evaluating the use of steroid or stent based interventions for stricture prophylaxis post-ESD. Two reviewers screened and extracted data at title/abstract, and full-text levels. Baseline patient characteristics, interventions, and outcomes were extracted. The primary outcome was stricture prevalence post-ESD with prophylactic steroids or stenting. Secondary outcomes were the number of adverse events associated with prophylactic interventions, and the number of balloon dilation re-intervention sessions after stricture formation. Using a random effects model, pooled risk ratio (RR) with 95% confidence intervals (CI) were calculated. Overall certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Results From 550 articles captured in the literature search, 4 RCTs were included in the final analysis. Two RCTs evaluated steroids (one comparing two different steroids, one comparing steroids with no intervention), and the remaining two RCTs focused on stents (one comparing two different stents, one comparing stents with no intervention). The pooled RR of post-ESD stricture formation was significantly lower with the use of steroids compared to stents (RR Steroids=0.32, 0.22; 0.47. RR Stents=0.36, 0.22; 0.59)(p<0.01). Among studies with no intervention for comparison, the pooled RR was 0.49 (0.16; 1.51, p=0.21) for post-ESD stricture formation, with no significant differences between prophylactic steroids or stenting. The proportion of adverse events was significantly higher with steroid use (0.23, 0.15; 0.33) compared to stents (0.02, 0.00; 0.08) (p<0.01). Comparing the number of re-intervention sessions needed for patients who received prophylactic steroids compared to stents demonstrated an odds ratio with a prediction interval of 2.81 (1.56; 4.07) (p=0.6), with patients receiving steroids or stents requiring a mean number of re-intervention sessions of 2.41 (1.09; 3.74) and 3.24 (0.47; 6.00) respectively. Conclusions In this analysis of 4 RCT’s evaluating steroids or stents for prophylactic stricture prevention post-ESD, the RR of stricture formation was significantly lower with steroids compared to stents. The proportion of adverse events was significantly higher with prophylactic steroid use, suggesting that the safety profile of steroid prophylaxis must be considered even in the context of superior efficacy. Future analysis should compare and evaluate the efficacy of prophylactic steroids or stents using RCT's to improve the quality of currently available data. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,019 | 0,027 |
| Bibliométrie | 0,003 | 0,004 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».