Advertisement

Impact of topical budesonide on prevention of esophageal stricture after mucosal resection

Published:December 09, 2020DOI:https://doi.org/10.1016/j.gie.2020.11.026

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Soetikno R.
        • Kaltenbach T.
        • Yeh R.
        • et al.
        Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract.
        J Clin Oncol. 2005; 23: 4490-4498
        • Ono S.
        • Fujishiro M.
        • Niimi K.
        • et al.
        Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms.
        Gastrointest Endosc. 2009; 70: 860-866
        • Lewis J.J.
        • Rubenstein J.H.
        • Singal A.G.
        • et al.
        Factors associated with esophageal stricture formation after endoscopic mucosal resection for neoplastic Barrett's esophagus.
        Gastrointest Endosc. 2011; 74: 753-760
        • Mizuta H.
        • Nishimori I.
        • Kuratani Y.
        • et al.
        Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer.
        Dis Esophagus. 2009; 22: 626-631
        • Katada C.
        • Muto M.
        • Manabe T.
        • et al.
        Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions.
        Gastrointest Endosc. 2003; 57: 165-169
        • Kochhar R.
        • Makharia G.K.
        Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures.
        Gastrointest Endosc. 2002; 56: 829-834
        • Hanaoka N.
        • Ishihara R.
        • Takeuchi Y.
        • et al.
        Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study.
        Endoscopy. 2012; 44: 1007-1011
        • Hashimoto S.
        • Kobayashi M.
        • Takeuchi M.
        • et al.
        The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection.
        Gastrointest Endosc. 2011; 74: 1389-1393
        • Yamaguchi N.
        • Isomoto H.
        • Nakayama T.
        • et al.
        Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma.
        Gastrointest Endosc. 2011; 73: 1115-1121
        • Yang J.
        • Wang X.
        • Li Y.
        • et al.
        Efficacy and safety of steroid in the prevention of esophageal stricture after endoscopic submucosal dissection: A network meta-analysis.
        J Gastroenterol Hepatol. 2019; 34: 985-995
        • Dohil R.
        • Newbury R.
        • Fox L.
        • et al.
        Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial.
        Gastroenterology. 2010; 139: 418-429
        • Bahin F.F.
        • Jayanna M.
        • Williams S.J.
        • et al.
        Efficacy of viscous budesonide slurry for prevention of esophageal stricture formation after complete endoscopic mucosal resection of short-segment Barrett's neoplasia.
        Endoscopy. 2016; 48: 71-74
        • Wang W.
        • Ma Z.
        Steroid administration is effective to prevent strictures after endoscopic esophageal submucosal dissection: a network meta-analysis.
        Medicine (Baltimore). 2015; 94: e1664

      Linked Article