ArticleInternational journal of surgery (London, England)2026
Pharmacological therapy for preventing esophageal stricture after endoscopic submucosal dissection: a systematic review and network meta-analysis.
Article in International journal of surgery (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveEndoscopic submucosal dissection (ESD) is a commonly used minimally invasive technique for treating early esophageal tumors. Postoperative esophageal stricture is a frequent complication. This study aimed to compare the efficacy of existing pharmacological therapies in preventing esophageal stricture after ESD and to determine the most effective regimen to inform clinical practice.
methodsA systematic literature search of the Cochrane Library, Embase, PubMed, and Web of Science databases was performed from inception to 20 March 2025. The main search terms included "endoscopic mucosal resection" and "ESD." The main outcome assessed was the incidence of esophageal stricture, while the secondary outcome involved the number of endoscopic balloon dilatation (EBD) sessions needed to manage severe postoperative strictures. This network meta-analysis was conducted using random-effects models. Mean differences (MDs) and relative risks (RRs) were estimated along with their 95% credible intervals (CrIs). Interventions were ranked based on the surface under the cumulative ranking curve (SUCRA) values. All statistical analyses were conducted using R software (version 4.5.0).
resultsThirty-one studies involving 3085 patients who underwent ESD were included. In terms of esophageal stricture incidence, oral hydrocortisone sodium succinate combined with aluminum phosphate gel demonstrated the greatest reduction in the risk of stricture compared with standard care (RR = 0.075, 95% CrI: 0.017, 0.24; SUCRA = 95.21%). Regarding the number of EBD sessions, the combination of polyglycolic acid (PGA) sheet plus fibrin glue resulted in the fewest sessions compared with standard care (MD = - 6.4, 95% CrI: - 8.4, - 4.3; SUCRA = 95.82%).
conclusionsIn patients undergoing ESD, oral hydrocortisone sodium succinate combined with aluminum phosphate gel was the most effective intervention for reducing the incidence of postoperative esophageal stricture. The combination of PGA sheet plus fibrin glue was most effective in minimizing the number of EBD sessions required.
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