Comments on “Local triamcinolone injection and selective add-on oral steroids to prevent esophageal post-endoscopic submucosal dissection stricture”

We read with great interest the article by Carpentier et al. [1] reporting the use of local triamcinolone injection and selective add-on oral steroids to prevent esophageal post-endoscopic submucosal dissection (ESD) stricture; however, we have some comments regarding this study.

First, this study included three groups of patients categorized on the basis of the degree of circumferential resection (<50%, 50%–89%, and ≥90%); however, both the previous literature [2] and the data from this study have indicated that the incidence of postoperative stricture is minimal for patients with circumferential resections of <50%. Furthermore, the authors did not provide any specific postoperative management for this group. Including these patients appeared unnecessary and might have artificially lowered the overall incidence of postoperative strictures.

Second, previous studies have reported post-ESD esophageal stricture rates for resections involving more than 50%, 75%, and 90% of the esophageal circumference [3], but the grouping used in the study of Carpentier et al. was 50%–89% and ≥90%. As this study was a noncomparative retrospective study, its results can only be compared with the previous literature. This inconsistency in the grouping compared with most prior studies made it challenging to evaluate the feasibility of the findings.

Third, the study reported 111 patients who underwent 130 ESD procedures, implying that some patients underwent multiple ESDs. If postoperative strictures occurred in these patients, how was it determined which ESD site caused the stricture? Would multiple ESDs have influenced the incidence of postoperative strictures? During patient selection, would it not have been more appropriate to include only patients who underwent a single ESD?

Fourth, during the study, patients were continuously censored for various reasons, and endoscopic follow-up at 3–6 months was available for only 58% of patients (75/130). The authors used the total number of ESD procedures as the denominator, instead of the total number of patients, which is confusing. Does the high rate of loss to follow-up compromise the reliability of these results?

In general, although this research had several limitations, it still provided useful clinical evidence of a systematic steroid administration protocol for post-ESD stricture prevention in a Western center.

Publication History

Article published online:
22 April 2025

• References

• 1 Carpentier D, Englebert G, Otero Sanchez L. et al. Local triamcinolone injection and selective add-on oral steroids to prevent esophageal post-endoscopic submucosal dissection stricture: a retrospective analysis in a Western center. Endoscopy 2024; 56: 811-819
• 2 Shi Q, Ju H, Yao LQ. et al. Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma. Endoscopy 2014; 46: 640-644
• 3 Ono S, Fujishiro M, Niimi K. et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy 2009; 41: 661-665