Esophageal stricture prevention post endoscopic sub - mucosal dissection Running title - Prophylaxis for esophageal stricture

Advancement in diagnostic modalities and improvement in surveillance programs for Barrett esophagus has resulted in increase in incidence of superficial esophageal cancers (SEC). SEC, due to their limited metastatic potential are amenable to non-invasive treatment modalities. Endoscopic ultrasound (EUS), endoscopic mucosal resection (EMR) and endoscopic sub-mucosal dissection (ESD) are few new modalities that gastroenterologist have used in last decade to diagnose and treat SEC. Esophageal stricture (ES) is a very common complication and a major cause of morbidity post ESD. In past few years there here has been a tremendous effort to reduce the incidence of ES among patients undergoing ESD. Steroids have shown most consistent results over time with minimum complications. Although, the preferred mode of delivery still remains debatable with both systemic and local therapy having its own pros and cons for specific subgroup of patients. Newer modalities like esophageal stents, autologous cell sheet transplantation, polyglycolic acid and tranilast have shown promising results but the depth of experience is still limited. We have summarized case reports, prospective single center studies and randomized controlled trials describing the various methods aiming to reduce the incidence of ES post ESD. Indications, techniques, outcomes, limitations and complications reported are discussed.