Background and Aims
EMR and endoscopic submucosal dissection (ESD) are treatment modalities for Barrett’s
esophagus involving high-grade dysplasia or early cancer. Injectional corticosteroid
therapy decreases the risk of procedure-related esophageal stricture (ES) formation.
Our aim was to assess the efficacy of topical budesonide on the rate of ES formation
after EMR or ESD.
Methods
Patients included prospectively from 3 tertiary endoscopy centers received 3 mg budesonide
orally twice a day for 8 weeks after esophageal EMR or ESD of 50% or more of the esophageal
circumference between January 1, 2014 and June 30, 2018. These patients were matched
(1:3 ratio) retrospectively with a consecutive patient cohort who underwent EMR or
ESD of 50% or more of the esophageal circumference without concomitant corticosteroid
therapy. The primary endpoint was the presence of ES at the 12-week follow-up.
Results
Twenty-five patients (budesonide) were matched with 75 patients (no budesonide). Most
underwent EMR for Barrett’s esophagus with biopsy-proven high-grade dysplasia or suspected
T1a cancer. Although most baseline characteristics did not differ significantly, patients
in the budesonide cohort tended to have a higher proportion of circumferential EMR.
The proportion of patients with ES was not significantly lower in the budesonide cohort
(16% vs 28%). On logistic regression analysis, budesonide remained associated with
a lower incidence of ES (P = .023); however, when controlling for baseline characteristics with a propensity
score weighted logistic regression model, there was no significant effect on ES formation
(P = .176).
Conclusions
Topical budesonide might be associated with a reduction of ES after EMR or ESD; however,
further studies are needed to verify our results.
Abbreviations:
BE (Barrett’s esophagus), ES (esophageal stricture), ESD (endoscopic submucosal dissection)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 09, 2020
Accepted:
November 28,
2020
Received:
July 30,
2020
Footnotes
If you would like to chat with an author of this article, you may contact Dr Bartel at [email protected]
DISCLOSURE: Dr Tokar: Food and beverage from Boston Scientific; Dr Wallace: Consultant for Virgo Inc, Cosmo/Aries Pharmaceuticals, Anx Robotica (2019), Covidien, and GI Supply; Consultant on behalf of the Mayo Clinic for GI Supply (2018), Endokey, Endostart, Boston Scientific, and Microtek; Research grants from Fujifilm, Boston Scientific, Olympus, Medtronic, Ninepoint Medical, and Cosmo/Aries Pharmaceuticals; Stock options from Virgo Inc; Minor food/beverage from Synergy Pharmaceuticals, Boston Scientific, and Cook Medical. All other authors disclosed no financial relationships.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Impact of topical budesonide on prevention of esophageal stricture after mucosal resectionGastrointestinal EndoscopyVol. 93Issue 6
- PreviewWe congratulate Bartel et al1 on their study. We do agree with the authors' conclusion that topical budesonide may be associated with a reduction of esophageal stricture after EMR or endoscopic submucosal dissection (ESD). Although it is a fine study, we would like to share our reservations and questions for further research.
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