Steroids or stenting for stricture prevention after endoscopic submucosal dissection: A systematic review and meta-analysis of randomized controlled trials
Bibliographic record
Abstract
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
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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 | 0.007 | 0.016 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.027 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 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".