Review Article

Progress on the Prevention of Esophageal Stricture after Endoscopic Submucosal Dissection

Table 1

Treatments for the prevention of esophageal stricture after endoscopic submucosal dissection.

GroupMechanismsAdvantagesDisadvantages and limitations

Pharmacological treatmentSteroidAnti-inflammatory, antifibrotic formation, antiscar formationEffective in many small comparative clinical studiesHard to prevent stricture in patients with circumferential esophageal mucosal defects, systematic side effects (peptic ulcers, immune suppression metabolic disturbances, and psychiatric symptoms), and delayed wound healing
Antifibrotic drugInhibit the proliferation of fibrous scarsAntifibrotic effectNo randomized controlled trials or systematic reviews with sufficient evidence
Esophageal stent treatmentEsophageal self-expandable stentsExpand the esophagusPersistently expand the esophagus, easily to be removed at any timeAdverse reactions (bleeding, chest pain, esophageal perforation, and stent migration), high recurrence after stent removal, and long-term effects were unknown
Biodegradable stentsExpand the esophagusExpand the esophagus, no need to removeNo randomized controlled trials or systematic reviews with sufficient evidence
Tissue engineering approachesExtracellular matrix scaffoldSupport the growth of epithelial cells, promote esophageal structure remodelingSupport tissue, enhance mucosal healing and structure remodelingPotential safety problem, no randomized controlled trials, or systematic reviews with sufficient evidence
Cell-based therapyPromote reepithelialization and scarless wound healingReepithelialization, enhancement of mucosal healing and structure remodeling, great potential for developmentComplicated technique, high cost, large-sample controlled trial, and long-term follow-up research are needed