Efficacy of prednisone for prevention of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma

BACKGROUND Our objective was to investigate the efficacy and safety of oral prednisone for the prevention of esophageal stricture formation after endoscopic submucosal dissection (ESD) in an optimal administration program. METHODS Patients who underwent circumferential or semi-circumferential (more than three quarters but not a complete circular) ESD for esophageal squamous cell carcinoma were eligible for this study. Oral prednisolone was administered to the study group at a dose of 30 mg/day on the third day post-ESD, and then tapered gradually (30, 25, 20, 15, 10, and 5 mg for 14 days). Serial esophagoscopy with iodine staining was performed to assess stenosis and tumor recurrence at one, three, six, and 12 months after ESD. Endoscopic balloon dilatation was performed whenever patients experienced persistent dysphagia to solids. Data were statistically analyzed. RESULTS Twenty-three patients (15 men, mean age 66.6 years) were enrolled in the study. Post-procedural esophageal stricture was significantly lower in the study group (23.1%) compared to the control (80%) (P < 0.05). A significantly higher number of endoscopic balloon dilatation sessions were performed (P < 0.05) in the control (13.5) than in the study group (0.69). There were no adverse events related to oral prednisolone or the procedure itself and no treatment-related mortality was observed during the 12 month follow-up. CONCLUSIONS Our study suggested an optimal administration program of oral prednisone therapy and demonstrated that it is safe and effective for the prevention of esophageal stricture in patients after complete or semi-circular ESD for esophageal squamous cell carcinoma.