目的:内镜黏膜下剥离术(ESD)是目前治疗浅表性食管癌(SEC)的标准治疗方法。然而,术后黏膜缺损常导致食管狭窄。虽然类固醇的应用是有效的预防,各种类固醇给药模式的有效性和安全性尚不清楚.因此,本研究旨在评估ESD后SEC患者不同类固醇给药的有效性和安全性.
方法:对中国国家知识基础设施进行了相关研究的搜索,万方数据库,PubMed,Embase,和WebofScience截至2024年3月25日。治疗策略分为四组:无预防控制(CON),类固醇注射(SI),口服类固醇(OS),和SI结合OS(SI+OS)。进行了比较荟萃分析以评估结果,包括术后食管狭窄率和狭窄后所需的内镜下球囊扩张术(EBD)次数。
结果:共25项研究,涉及1555名患者,包括在内。SUCRA评分为:SI+OS(98.9%)>OS(59.9%)>SI(41.2%)>CON(0.0%),和OS(76.9%)>SI+OS(62.1%)>SI(61.0%)>CON(0.0%)所需的EBD会话数量。森林地块结果表明,与非类固醇组相比,类固醇干预与较低的术后狭窄率和较少的EBD疗程相关.此外,SI+OS在防止狭窄方面优于SI或单独的OS,在EBD会话方面,不同类固醇给药之间没有显着差异。所有干预措施的不良反应发生率均低于10%。大多温和,停药后可解决。
结论:这项研究表明,联合给药对于预防ESD后患者的食管狭窄似乎更可取,和类固醇可以提高狭窄的预后。然而,由于缺乏比较不同类固醇给药的大样本RCT研究,未来需要更多高质量的研究来证实这些发现。
OBJECTIVE: Endoscopic submucosal dissection (ESD) is the standard therapy for superficial esophageal cancer (SEC) presently. However, postoperative mucosal defects often lead to esophageal stricture. Although
steroid application is effective prophylaxis, the efficacy and safety of various
steroid administration modes remain unclear. Thus, this study aimed to evaluate the efficacy and safety of different
steroid administrations for SEC patients post-ESD.
METHODS: A search for relevant studies was conducted on
China National Knowledge Infrastructure, Wanfang Database, PubMed, Embase, and Web of Science up to March 25, 2024. Treatment strategies were categorized into four groups: no prevention as control (CON),
steroid injection (SI), oral steroids (OS), and SI combined with OS (SI+OS). Comparative meta-analysis was conducted to assess outcomes, including postoperative esophageal stricture rate and the number of endoscopic balloon dilatation (EBD) sessions required after stricture.
RESULTS: A total of 25 studies, involving 1555 patients, were included. The SUCRA rankings were as follows: SI+OS (98.9%) > OS (59.9%) > SI (41.2%) > CON (0.0%) in preventing postoperative esophageal stricture rate, and OS (76.9%) > SI+OS (62.1%) > SI (61.0%) > CON (0.0%) in the number of EBD sessions required. Forest plot results indicated that compared with the non-
steroid group,
steroid interventions were associated with lower rates of postoperative stricture and fewer EBD sessions. Additionally, SI+OS was superior to SI or OS alone in preventing stricture, with no significant differences observed between different steroid administrations in terms of EBD sessions. The incidence of adverse reactions was less than 10% for all interventions, mostly mild and resolvable upon discontinuation.
CONCLUSIONS: This study suggests that combined administration appears preferable for preventing esophageal stricture in patients post-ESD, and steroids could enhance stricture prognosis. However, due to the lack of large-sample RCT studies comparing different steroid administrations, more high-quality research is necessary to confirm these findings in the future.