Steroid injection and polyglycolic acid shielding to prevent stricture after esophageal endoscopic submucosal dissection: a retrospective comparative analysis (with video)

Gastrointest Endosc. 2020 Dec;92(6):1176-1186.e1. doi: 10.1016/j.gie.2020.04.070. Epub 2020 May 4.


Background and aims: Postoperative stricture after expansive esophageal endoscopic submucosal dissection (ESD) is a severe adverse event. Previous single-arm reports have suggested that polyglycolic acid (PGA) shielding may prevent stricture. This study was performed to assess the efficacy of this method through a comparative analysis.

Methods: This is a retrospective analysis of 500 consecutive cases of esophageal ESD performed between 2002 and 2018 at the University of Tokyo Hospital. After 2013, patients with a diagnosis of superficial esophageal carcinoma covering more than half of the esophageal circumference underwent preventive treatment with either PGA shielding or steroid injection + PGA shielding after ESD. The efficacy of these methods for preventing post-ESD stricture was assessed through multivariable logistic regression analysis.

Results: The risk of postoperative stricture was especially high in the cervical esophagus (odds ratio [OR], 4.60; 95% confidence interval [CI], 0.65-61.09) and after total circumferential resection (OR, 3.58×103; lower bound of 95% CI, >185). Steroid injection + PGA shielding was the only method significantly effective in preventing stricture (OR, 0.30; 95% CI, 0.10-0.78; P = .009). In the relatively low-risk subgroup (excluding cervical esophageal cancer and complete circumferential resection), the postoperative stricture rates for steroid injection + PGA shielding versus PGA shielding versus control were 18.9% versus 41.4% versus 51.7%, respectively (P = .015). However, the efficacy of this was limited in extremely high-risk cases.

Conclusion: The combination of steroid injection and PGA shielding is effective for preventing post-ESD stricture. There is a need for even more effective methods for cervical esophageal cancer and complete circumferential resection.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biocompatible Materials
  • Carcinoma, Squamous Cell / surgery*
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / prevention & control
  • Endoscopic Mucosal Resection* / adverse effects
  • Esophageal Neoplasms* / surgery
  • Esophageal Stenosis* / etiology
  • Esophageal Stenosis* / prevention & control
  • Female
  • Fibrin Tissue Adhesive / administration & dosage
  • Glucocorticoids / administration & dosage*
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Polyglycolic Acid / administration & dosage*
  • Polymers / administration & dosage
  • Retrospective Studies
  • Triamcinolone / administration & dosage


  • Biocompatible Materials
  • Fibrin Tissue Adhesive
  • Glucocorticoids
  • Polymers
  • Triamcinolone
  • Polyglycolic Acid