Impact of topical budesonide on prevention of esophageal stricture after mucosal resection.
Gastrointest Endosc
; 93(6): 1276-1282, 2021 06.
Article
in En
| MEDLINE
| ID: mdl-33309653
ABSTRACT
BACKGROUND AND AIMS:
EMR and endoscopic submucosal dissection (ESD) are treatment modalities for Barrett's esophagus involving high-grade dysplasia or early cancer. Injectional corticosteroid therapy decreases the risk of procedure-related esophageal stricture (ES) formation. Our aim was to assess the efficacy of topical budesonide on the rate of ES formation after EMR or ESD.METHODS:
Patients included prospectively from 3 tertiary endoscopy centers received 3 mg budesonide orally twice a day for 8 weeks after esophageal EMR or ESD of 50% or more of the esophageal circumference between January 1, 2014 and June 30, 2018. These patients were matched (13 ratio) retrospectively with a consecutive patient cohort who underwent EMR or ESD of 50% or more of the esophageal circumference without concomitant corticosteroid therapy. The primary endpoint was the presence of ES at the 12-week follow-up.RESULTS:
Twenty-five patients (budesonide) were matched with 75 patients (no budesonide). Most underwent EMR for Barrett's esophagus with biopsy-proven high-grade dysplasia or suspected T1a cancer. Although most baseline characteristics did not differ significantly, patients in the budesonide cohort tended to have a higher proportion of circumferential EMR. The proportion of patients with ES was not significantly lower in the budesonide cohort (16% vs 28%). On logistic regression analysis, budesonide remained associated with a lower incidence of ES (P = .023); however, when controlling for baseline characteristics with a propensity score weighted logistic regression model, there was no significant effect on ES formation (P = .176).CONCLUSIONS:
Topical budesonide might be associated with a reduction of ES after EMR or ESD; however, further studies are needed to verify our results.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Barrett Esophagus
/
Esophageal Neoplasms
/
Adenocarcinoma
/
Esophageal Stenosis
/
Endoscopic Mucosal Resection
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Journal:
Gastrointest Endosc
Year:
2021
Type:
Article
Affiliation country:
United States