Prevention strategies of esophageal stenosis after endoscopic resection for superficial esophageal cancer: a Bayesian network meta-analysis.

IF 12.5 2区医学 Q1 SURGERY

International journal of surgery Pub Date : 2025-03-01 DOI:10.1097/JS9.0000000000002241

Yongqi Dong, Hongyan Xu, Wanli Yu, Zijing Liu, Gang Zhao, Zhihuan Zhang, Yuan Xia, Shiyong Xiao, Qianzhang Yi, Zebin Lin

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引用次数: 0

Abstract

Introduction: What interventions effectively prevent postoperative stenosis following endoscopic resection (ER) of superficial esophageal cancer? This study aimed to identify effective interventions or combinations through a systematic review and network meta-analysis.

Methods: Six databases were systematically searched for eligible studies up to 30 April 2023, on interventions to prevent esophageal stenosis post-ER. Odds ratios (ORs) evaluated stenosis rate (primary outcome) and complications (secondary outcome), while mean differences (MD) evaluated endoscopic balloon dilatation (EBD) sessions post-stenosis.

Results: Twenty-three studies involving 1271 patients and 11 different interventions were included. Eight interventions were effective in preventing post-ER stenosis: oral hydrocortisone sodium succinate and aluminum phosphate gel (OHA) (OR: 0.02, 95% credible interval [CrI]: 0.00-0.11), polyglycolic acid (PGA) + ST (OR: 0.02, 95% CrI: 0.00-0.23), oral tranilast (OT) + preemptive endoscopic balloon dilatation (PEBD) (OR: 0.08, 95% CrI: 0.01-0.77), botulinum toxin (BT) (OR: 0.10, 95% CrI: 0.03-0.32), ST (OR: 0.08, 95% CrI: 0.01-0.67), oral steroid (OS) (OR: 0.11, 95% CrI: 0.05-0.28), endoscopic triamcinolone injection (ETI) + OS (OR: 0.17, 95% CrI: 0.07-0.42), and ETI (OR: 0.18, 95% CrI: 0.11-0.30). Five interventions significantly reduced EBD sessions: PGA + ST (MD: -5.78, 95% CrI: -11.04 to -1.21), ETI + OS (MD: -3.27, 95% CrI: -5.37 to -0.72), OS (MD: -6.18, 95% CrI: -9.43 to -3.38), ETI (MD: -3.81, 95% CrI: -5.74 to -1.99), and BT (MD: -2.16, 95% CrI: -4.12 to -0.40). None of the interventions significantly increased complications.

Conclusions: This study confirmed the efficacy of OS, ETI, and ETI + OS and verified five other interventions (OHA, PGA + ST, OT + PEBD, BT, and ST) in preventing stenosis. Notably, PGA + ST and BT also reduced the number of EBD sessions.

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浅表性食管癌内镜切除后食管狭窄的预防策略：贝叶斯网络meta分析。

导读：哪些干预措施能有效预防浅表性食管癌内镜切除术后狭窄？本研究旨在通过系统回顾和网络荟萃分析来确定有效的干预措施或组合。方法：系统检索6个数据库，检索截至2023年4月30日的有关干预措施预防er后食管狭窄的符合条件的研究。优势比（ORs）评估狭窄率（主要结局）和并发症（次要结局），而平均差异（MD）评估狭窄后的内镜球囊扩张（EBD）。结果：纳入了23项研究，涉及1271例患者和11种不同的干预措施。8种干预措施可有效预防er后狭窄：口服氢化可的松琥珀酸钠磷酸铝凝胶（OHA）（OR: 0.02, 95%可信区间[CrI]: 0.00-0.11）、聚乙醇酸(PGA) + ST （OR: 0.02, 95%可信区间[CrI]: 0.00-0.23）、口服曲尼司特(OT) +先发制人的内镜球囊扩张（PEBD）（OR: 0.08, 95%可信区间[CrI]: 0.01-0.77）、肉毒毒素（BT）（OR: 0.10, 95%可信区间[CrI]: 0.03-0.32）、ST （OR: 0.08, 95%可信区间[CrI]: 0.01-0.67）、口服类固醇（OS）（OR: 0.11, 95%可信区间[CrI]: 0.11）。0.05-0.28)、内窥镜曲安奈德注射(ETI) + OS （OR: 0.17, 95% CrI: 0.07-0.42）和ETI （OR: 0.18, 95% CrI: 0.11-0.30）。五种干预措施显著减少了EBD会话：PGA + ST (MD: -5.78, 95% CrI: -11.04至-1.21),ETI + OS (MD: -3.27, 95% CrI: -5.37至-0.72),OS (MD: -6.18, 95% CrI: -9.43至-3.38),ETI （MD: -3.81, 95% CrI: -5.74至-1.99）和BT （MD: -2.16, 95% CrI: -4.12至-0.40）。所有干预措施均未显著增加并发症。结论：本研究证实了OS、ETI和ETI + OS的有效性，并验证了其他五种干预措施（OHA、PGA + ST、OT + PEBD、BT和ST）预防狭窄的有效性。值得注意的是，PGA + ST和BT也减少了EBD会话的数量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of surgery SURGERY-

CiteScore

17.70

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.