Predictive factors for esophageal stenosis in patients receiving prophylactic steroid therapy after endoscopic submucosal dissection for esophageal squamous cell carcinoma

Background: Methods to prevent esophageal stenosis (ES) after endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (ESCC) have received increasing attention. Although steroid administration is a prophylactic treatment, steroid use may also be a risk factor for ES. Therefore, we retrospectively evaluated risk factors for refractory ES in patients administered prophylactic steroids after ESD for ESCC. Methods Among 795 patients with ESCC (854 lesions), 180 patients (211 lesions) who received preventive administration of local triamcinolone acetonide (TrA) and/or oral administration of prednisolone were enrolled. We compared the total number of endoscopic balloon dilatation (EBD) procedures performed for post-ESD ES and clinical findings (tumor size, a history of ESD or chemoradiation therapy [CRT], entire circumferential resection, muscle layer damage, supplemental oral prednisolone administration, EBD with TrA injection, and additional CRT) between patients with refractory and non-refractory ES. EBD was continued until dysphagia resolved. Results Univariate analysis revealed (non-refractory group vs. refractory group) tumor size (34.4 ± 1.5 vs. 46.2 ± 1.5, p < 0.01), a history of CRT (8/144 vs. 9/50, p = 0.023), entire circumferential resection (19/133 vs. 28/31, p < 0.01), and supplemental oral prednisolone administration (72/80 vs. 20/39, p = 0.013) to be significantly associated with refractory ES (≥ 8 EBD). Moreover, multivariate analysis revealed that a history of CRT and entire circumferential resection were independently associated with refractory ES. The withdrawal rates of EBD at 3 years were 96.1% (52/53) and 58.5% (39/59) in the non-refractory and refractory groups, respectively. Conclusions Our data suggest that entire circumferential resection and a history of CRT are risk factors for refractory post-ESD ES in ESCC, even with prophylactic steroid administration.