| Purpose:Through Meta-analysis,the prevention effect of hormone on esophageal stricture after endoscopic submucosal dissection（ESD）and its effect on reducing the number of endoscopic balloon dilation（EBD）after esophageal stricture were discussed,in order to provide some basis for clinicians to choose the prevention strategy of esophageal stricture after ESD for early esophageal carcinoma.Method:Through the computer search database,including Pub Med Embase the Cochrane Library,we collected the related literature about the effect of hormone on preventing esophageal stricture after ESD operation of early esophageal cancer.The subject words and free words are used to construct a retrieval mode for retrieval.The retrieval time is from the establishment of the database to December 2021.Two researchers independently conduct literature screening and data extraction according to the established inclusion and exclusion criteria.If any dispute is found,it shall be decided by two researchers through consultation or by a more experienced third researcher.The included randomized controlled studies and non randomized controlled studies used Cochrane evaluation tool and Newcastle Ottawa scale（NOS）to evaluate the literature quality.Result:According to the inclusion and exclusion criteria,a total of 15 studies were included,and the esophageal mucosal defects of patients with early esophageal cancer after ESD were all greater than or equal to2/3 of the circumference of the esophagus.In terms of stenosis rate,989 patients from 15 studies were included in the analysis,including 552 patients in hormone group and 437 patients in control group.Hormone can reduce the incidence of esophageal stenosis after ESD（RR =0.31,95% CI: 0.23,0.42,Z = 7.64,P < 0.00001）;In terms of EBD expansion times after esophageal stenosis,584 patients were included in12 studies,including 345 patients in hormone group and 239 patients in control group.Hormone can reduce EBD expansion times after esophageal stenosis（MD=-3.19,95%CI:-4.69,-1.68,P < 0.00001）The effect of oral hormone combined with local injection on preventing esophageal stricture after ESD of esophageal cancer is better than that of single use,and the effect of oral hormone on reducing EBD expansion times is better than that of local injection of hormone.Oral hormone can reduce the incidence of esophageal stricture with non-total circumferential mucosal defect（≥2/3,<1）after ESD of esophageal lesions,but it has no obvious effect on preventing esophageal stricture with total circumferential mucosal defect after ESD of esophageal lesions.In this paper,there are 11 studies on complications of hormone use,including406 cases in hormone group,and 9 literatures about hormone-related adverse reactions.The intervention measures of Jing 2018 are local injection of hormone combined with oral administration of hormone,with one case of severe infection.In Yang 2021,there was one case of severe infection in the group with local injection of hormone,and the incidence of adverse events was 0.5%（2/406）.Considering that most of the studies included in this paper did not find hormone adverse events.Conclusion:It is safe and effective to use hormone to prevent esophageal stenosis after ESD for early esophageal cancer（mucosal defect ≥ 2/3circumference）.（1）oral administration combined with local injection of hormone is better than single use in reducing the rate of esophageal stenosis;（2）Oral hormone was superior to local injection in reducing the rate of esophageal stenosis and the number of EBD;（3）Oral corticosteroids can reduce the incidence of esophageal stenosis in non circumferential mucosal defect after ESD for early esophageal cancer,but have no significant effect on preventing esophageal stenosis in circumferential mucosal defect after ESD for early esophageal cancer;（4）The incidence of hormone related serious adverse events was 0.5%（2/406）,indicating that the use of hormones to prevent esophageal stricture after ESD for early esophageal cancer is relatively safe. |
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