Reply to Wang et al.

We read with great interest the letter from Dr. Wang and colleagues and thank the authors for recognizing the usefulness of a systematic steroid administration protocol to prevent post-endoscopic submucosal dissection (ESD) esophageal stricture in Western centers.

We prospectively adopted a systematic stricture preventive protocol [1] based on the size of post-ESD resected field: (i) <50% of circumference, no need for steroid-based preventive regimen because the risk of stricture is minimal, as was confirmed in our study; (ii) 50%–89% of the circumference, local steroid injection alone; (iii) ≥90% circumference, local steroid injection and add-on oral steroids because the risk of stricture is higher in this group. For the reader’s understanding of a clear post-ESD protocol, keeping the low risk group in the study was important to reinforce the message that no preventive measure is needed in this subgroup.

There were indeed 12/111 patients treated in our cohort who had multiple ESD procedures (two ESDs [n = 7], three ESDs [n = 4], and five ESDs [n = 1]). Among these patients, none presented with a stricture, meaning this did not interfere with the presented outcomes analyzed by ESD number. Similarly, the so-called “loss to follow-up” suspected by Wang et al. is due to the fact that we of course censored patients at the time of esophageal surgery, Barrett radiofrequency ablation, or complementary esophageal resection to avoid confusing elements; no symptomatic strictures were observed between the ESD procedure and the time of censoring these patients. Therefore, we ensured that the presented data are purely associated with our stricture preventive policy.

We underline that, for patients with a resection field covering 50%–89% of the circumference, weeks of oral steroids might be simply replaced by a few minutes of intervention with a local steroid injection given just at the end of the ESD procedure.

Publikationsverlauf

Artikel online veröffentlicht:
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