Efficacy of steroid in prevention of esophageal strictures after endoscopic submucosal dissection for early esophageal cancer: A meta-analysis

doi:10.3877/cma.j.issn.2095-7157.2018.05.002

Abstract

Abstract:

Objective

To evaluate the efficacy of steroid in prevention of stricture after endoscopic submucosal resection(ESD) for early esophageal cancer.

Methods

Researches published in CBM, Pubmed, EMbase, the Cochrane Library database about the effect of steroid for prevention of stricture after ESD for early esophageal cancer were retrieved and screened.The expiration date for retrieval was in November 2017.RevMan5.3 software was used for the Meta-analysis.

Results

A total of 12 studies were included in the analysis, including 535 patients.The results of meta-analysis showed that local steroid injection could reduce the incidence of esophageal stricture (RR=0.41, 95%CI: 0.27-0.63, P<0.000 1). Oral steroid has no significant effect on reducing the incidence of esophageal stricture after circumferential ESD operation(RR=0.54, 95%CI: 0.16-1.84, P=0.33). It can reduce the incidence of esophageal stricture after semi-circumferential ESD surgery (RR=0.25, 95%CI: 0.11-0.54, P=0.0004). Both oral steroid (RR=-10.73, 95%CI: -15.47~-5.98, P<0.000 1) and local steroid injection (RR=-3.22, 95%CI: -5.11~-1.34, P=0.0008) can reduce required EBD sessions of esophageal stenosis.

Conclusions

Steroid for the prevention of stricture after ESD for early esophageal cancer is safe and effective; Oral steroid has no effect for the prevention of stricture after circumferential ESD, but can reduce stricture rate of semi-circumferential ESD for esophageal lesions; Both oral steroid and local steroid injection can reduce required EBD sessions for stricture.And for the effect of reducing required EBD sessions for stricture, oral steroid is better than that of local steroid injection.

Key words: Steroid, Endoscopic submucosal dissection, Early esophageal cancer, Prevention of stricture

Zhenjuan Li, Ningli Chai, Enqiang Linghu, Jia Feng, Yaqi Zhai. Efficacy of steroid in prevention of esophageal strictures after endoscopic submucosal dissection for early esophageal cancer: A meta-analysis[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2018, 05(01): 18-28.

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References 41

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纳入研究	研究对象选择	组间可比性	结果测量	合计
Hashimoto 2011^[9]	2	1	3	6
Isomoto 2011^[10]	3	1	3	7
Yamaguchi 2011^[11]	3	1	3	7
Hanaoka 2012^[12]	2	1	3	6
Sato 2013^[13]	3	1	3	7
Kataoka 2015^[14]	2	1	3	6
Kadota 2016 ^[15]	3	1	3	7
Nagami 2016^[16]	3	1	3	7
Tsujii 2017^[17]	3	1	3	7
Zhou 2017^[18]	3	1	3	7

纳入研究	研究对象选择	组间可比性	结果测量	合计
Hashimoto 2011^[9]	2	1	3	6
Isomoto 2011^[10]	3	1	3	7
Yamaguchi 2011^[11]	3	1	3	7
Hanaoka 2012^[12]	2	1	3	6
Sato 2013^[13]	3	1	3	7
Kataoka 2015^[14]	2	1	3	6
Kadota 2016 ^[15]	3	1	3	7
Nagami 2016^[16]	3	1	3	7
Tsujii 2017^[17]	3	1	3	7
Zhou 2017^[18]	3	1	3	7

纳入研究	研究设计	干预措施		病例数(S/C，n)	性别(男/女，n)	创面黏膜缺损程度	发生狭窄数(S/C，n)	EBD扩张次数(S/C)	激素相关不良事件，n
纳入研究	研究设计	病例组	对照组	病例数(S/C，n)	性别(男/女，n)	创面黏膜缺损程度	发生狭窄数(S/C，n)	EBD扩张次数(S/C)	激素相关不良事件，n
Tsujili 2017	队列研究	局部注射	无	28/10	37/1	<2/3，≥2/3	12/28；9/10	8(1－186)；5(2－12)	0
He 2017 ^[7]	RCT	口服＋局部注射	无	22/22/23	39/28	>3/4	4/22；3/22；17/23	2.1(0～4)；1.6(0～3)；6(0～13)	0
Zhou 2017	队列研究	口服激素	无	13/10	15/8	>3/4 to<4/4	3/13；8/10	0.69(0－3)；13.5(0～28)	0
Nagami 2016	配对病例对照研究	局部注射	无	28/28	46/10	≥2/3	3/28；10/28	未报告	未报告
Kadota 2016	队列研究	口服＋局部注射激素	无	82/33	99/16	≥3/4	35/82；22/33	未报告	1
Kataoka 2015	队列研究	口服激素	无	17/16	26/7	>3/4	3/17;11/16	4.6(2～10)；8.1(1～18)	0
Takahashi 2015 ^[8]	RCT	局部注射	无	16/16	25/7	≥3/4	10/16；14/16	6.1±6.2(0～17)；12.5±10.1(0～40)	0
Sato 2013	队列研究	口服激素＋EBD	EBD	10/13	21/2	4/4	10/10；13/13	13.8±6.9；33.5±22.9	0
Hanaoka 2012	队列研究	局部注射	无	30/29	53/6	≥3/4，<4/4	3/30；19/29	0(0～2)；2(0～15)	0
Yamaguchi 2011	队列研究	局部注射	EBD	22/19	35/6	≥3/4	1/19；7/22	1.7(0～7)；15.6(0～48)	0
Isomoto 2011	队列研究	口服激素	EBD	4/3	未报告	4/4	2/4；3/3	6.5(2～11)/32.7(20～48)	0
Hashimoto 2011	队列研究	局部注射	无	21/20	36/5	3/4	4/21；15/20	1.7(0－15);6.6(0－20)	0

纳入研究	研究设计	干预措施		病例数(S/C，n)	性别(男/女，n)	创面黏膜缺损程度	发生狭窄数(S/C，n)	EBD扩张次数(S/C)	激素相关不良事件，n
纳入研究	研究设计	病例组	对照组	病例数(S/C，n)	性别(男/女，n)	创面黏膜缺损程度	发生狭窄数(S/C，n)	EBD扩张次数(S/C)	激素相关不良事件，n
Tsujili 2017	队列研究	局部注射	无	28/10	37/1	<2/3，≥2/3	12/28；9/10	8(1－186)；5(2－12)	0
He 2017 ^[7]	RCT	口服＋局部注射	无	22/22/23	39/28	>3/4	4/22；3/22；17/23	2.1(0～4)；1.6(0～3)；6(0～13)	0
Zhou 2017	队列研究	口服激素	无	13/10	15/8	>3/4 to<4/4	3/13；8/10	0.69(0－3)；13.5(0～28)	0
Nagami 2016	配对病例对照研究	局部注射	无	28/28	46/10	≥2/3	3/28；10/28	未报告	未报告
Kadota 2016	队列研究	口服＋局部注射激素	无	82/33	99/16	≥3/4	35/82；22/33	未报告	1
Kataoka 2015	队列研究	口服激素	无	17/16	26/7	>3/4	3/17;11/16	4.6(2～10)；8.1(1～18)	0
Takahashi 2015 ^[8]	RCT	局部注射	无	16/16	25/7	≥3/4	10/16；14/16	6.1±6.2(0～17)；12.5±10.1(0～40)	0
Sato 2013	队列研究	口服激素＋EBD	EBD	10/13	21/2	4/4	10/10；13/13	13.8±6.9；33.5±22.9	0
Hanaoka 2012	队列研究	局部注射	无	30/29	53/6	≥3/4，<4/4	3/30；19/29	0(0～2)；2(0～15)	0
Yamaguchi 2011	队列研究	局部注射	EBD	22/19	35/6	≥3/4	1/19；7/22	1.7(0～7)；15.6(0～48)	0
Isomoto 2011	队列研究	口服激素	EBD	4/3	未报告	4/4	2/4；3/3	6.5(2～11)/32.7(20～48)	0
Hashimoto 2011	队列研究	局部注射	无	21/20	36/5	3/4	4/21；15/20	1.7(0－15);6.6(0－20)	0

研究结局		研究数量	例数(S/C)	RR/MD(95%CI)	P值
狭窄率		?	?	?	?
?	口服激素	5	68/71	0.36(0.05，2.41)	0.29
?	局部注射激素	5	176/110	0.53(0.38，0.74)	0.0002
?	合计	10	244/181	0.44(0.25，0.76)	0.003
EBD次数		?	?	?	?
?	口服激素	5	68/71	－5.98(－7.27, －4.70)	<0.00001
?	局部注射激素	3	66/49	－4.28(－5.64, －2.93)	<0.00001
?	总体	8	134/120	－5.18(－6.11，－4.25)	<0.00001

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