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Bartel MJ , Mousa OY , Brahmbhatt B , Coffman DL , Patel K , Repici A , Tokar JL , Wolfsen HC , Wallace MB
Impact of topical budesonide on prevention of esophageal stricture after mucosal resection
Gastrointest Endosc. 2021 Jun;93(6) :1276-1282
PMID: 33309653 URL: https://www.ncbi.nlm.nih.gov/pubmed/33309653
AbstractBACKGROUND AND AIMS: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are treatment modalities for Barrett's esophagus containing high-grade dysplasia or early cancer. Injectional corticosteroid therapy decreases risk of procedure-related esophageal stricture (ES) formation. Our aim was to assess the efficacy of topical budesonide on rate of ES formation after EMR or ESD. METHODS: Prospectively included patients 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 (1:3 ratio) with a retrospective, consecutive patient cohort who underwent EMR or ESD of 50% or more esophageal circumference without concomitant corticosteroid therapy. The primary end point was presence of ES at 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%). In logistic regression analysis, budesonide remained associated with lower incidence of ES (P = .023); however, when controlling 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.
Notes1097-6779 Bartel, Michael J Mousa, Omar Y Brahmbhatt, Bhaumik Coffman, Donna L Patel, Krupa Repici, Alessandro Tokar, Jeffrey L Wolfsen, Herbert C Wallace, Michael B Journal Article United States Gastrointest Endosc. 2020 Dec 9:S0016-5107(20)35035-5. doi: 10.1016/j.gie.2020.11.026.