The Role of Preventative Therapies in Stricture Formation Post Esophageal Endoscopic Resection
Bibliographic record
Abstract
Aims Endoscopic resection is the standard of care for superficial esophageal neoplasms. Advances in techniques have allowed extensive resections resulting in circumferential defects, but this substantially increases the risk of stricture formation requiring ongoing intervention. Several prophylactic strategies have been described to mitigate the stricture risk, yet a comprehensive understanding of their usefulness remains uncertain. The aim of this study is to review and analyse the current literature with regards to stricture prophylaxis. Methods A literature search was conducted using Ovid MEDLINE All, Ovid Embase Classic+Embase, Scopus, CINAHL Complete via EBSCOhost, and Ovid EBM Reviews – Cochrane Central Register of Controlled Trials from database inception to August 1, 2023. Randomized controlled trials (RCTs) and observational studies (retrospective or prospective) focusing on prophylactic stricture prevention interventions were included. Standard meta-analyses were employed using the random-effects model, and heterogeneity was assessed by I2% statistics. Results The interventions included steroids, botulinum toxin, mechanical therapies, and novel or emerging techniques, compared to either no therapy or alternative prophylactic therapy. The pooled stricture/restenosis rate in the no-intervention group was 51.2% (95% CI: 36.6-65.6; I2=90%) across 16 studies. Notably, oral steroid administration demonstrated a significantly lower pooled stricture/restenosis rate at 27.6% (95% CI: 18.7-38.7; I2=0%) across 11 studies. Steroid injection and balloon dilation presented pooled rates of 28.1% (95% CI: 16.9-43; I2=79%) and 66.8% (95% CI: 48.4-81.2; I2=55%). There was a substantial risk reduction in stricture/restenosis with steroid injection with a pooled risk ratio of 0.44 (95% CI: 0.29-0.65; P<0.001), oral steroid administration (RR 0.43, 95% CI: 0.25-0.73; P=0.002) and topical steroid application (RR 0.46, 95% CI: 0.23-0.91; P=0.02). Additionally, the combination of Polyglycolic Acid (PGA) and stent intervention presented a compelling risk ratio of 0.41 (95% CI: 0.23-0.74; P 0.003) when compared to stent alone. Conclusions Our study highlights the varying effectiveness of prophylactic interventions in preventing esophageal stricture formation post-endoscopic resection. Notably, oral steroid administration and steroid injection showed significant reductions in stricture rates as compared to no interventions. PROSPERO (CRD42022335103) Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".