Analysis of the effect of statins combined with glucocorticoids on esophageal stricture after large-area endoscopic submucosal dissection

doi:10.3969/j.issn.1674-8115.2026.08.011

Abstract

Abstract:

Objective ·To evaluate the efficacy of statins combined with glucocorticoids in preventing esophageal stricture after large-area endoscopic submucosal dissection (ESD). Methods ·This was a retrospective cohort study. Patients who underwent ESD for early-stage esophageal carcinoma and precancerous lesions with a surgical wound covering ≥3/4 of the circumference in the Department of Gastroenterology, Hebei Medical University Third Hospital, from January 2015 to January 2023 were enrolled. Patient baseline data, surgery-related information, and postoperative follow-up data were collected. All patients received oral prednisone acetate postoperatively. Patients were categorized into two groups based on statin administration: an oral glucocorticoid group and an oral glucocorticoid plus statin group. The two groups were compared in terms of the incidence of postoperative esophageal stricture, time to first stricture onset, number of balloon dilations after stricture formation, and adverse reactions. Multivariate Logistic regression analysis was employed to identify risk factors associated with esophageal stricture. Results ·A total of 53 patients were enrolled, including 32 in the oral glucocorticoid group and 21 in the oral glucocorticoid plus statin group. There were significant differences in the prevalence of coronary heart disease, cerebral infarction, and hyperlipidemia between the two groups (all P<0.05). However, no significant differences were observed in gender, age, body mass index (BMI), smoking history, drinking history, history of hypertension or diabetes, esophageal lesion location, lesion invasion depth, postoperative pathological results, and longitudinal length of resected mucosa. A total of 16 patients developed postoperative esophageal stricture in the 53 patients, with an overall stenosis rate of 30.2%. The oral glucocorticoid group exhibited a higher stricture rate compared with the oral glucocorticoid plus statin group (37.5% vs 19.0%), though this difference was not statistically significant (P=0.152). After esophageal stricture occurred, the number of balloon dilations was significantly lower in the oral glucocorticoid plus statin group than in the oral glucocorticoid group [(1.50±0.58) times vs (2.33±0.65) times, P=0.040]. There were no significant differences in the time to first stricture onset between the two groups (P=0.368). Multivariate Logistic regression analysis identified circumferential wound involvement as a significant risk factor for esophageal stricture (OR=35.266, 95% CI 5.600‒222.103, P<0.001). However, the use of statins showed no statistically significant association with esophageal stricture (OR=0.216, 95% CI 0.033‒1.393, P=0.107). Conclusion ·The combination of glucocorticoids and statins can safely and effectively reduce the number of balloon dilatations and alleviate the severity of esophageal stricture in patients developing esophageal stricture after ESD.

Key words: esophageal stricture, statin, glucocorticoid, endoscopic submucosal dissection (ESD), esophageal neoplasm

CLC Number:

R571⁺.1

Song Hongzhao, Meng Xia, Jiang Tao, Li Tongtong, Li Zhenan, Wang Junmin. Analysis of the effect of statins combined with glucocorticoids on esophageal stricture after large-area endoscopic submucosal dissection[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(8): 1109-1116.

Figures/Tables 4

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References 26

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Characteristic	Oral glucocorticoid group (n=32)	Oral glucocorticoid plus statin group (n=21)	t/χ² value	P value
Gender/n(%)			0.026	0.872
Male	19 (59.4)	12 (57.1)
Female	13 (40.6)	9 (42.9)
Age/year	61.88±7.53	64.95±9.18	-1.333	0.188
BMI/(kg·m^-2)	21.50±1.95	22.40±2.17	-1.579	0.121
Smoking/n(%)	15 (46.9)	15 (71.4)	3.112	0.078
Alcohol consumption/n(%)	14 (43.8)	14 (66.7)	2.672	0.102
Hypertension/n(%)	13 (40.6)	11 (52.4)	0.707	0.400
Diabetes mellitus/n(%)	4 (12.5)	3 (14.3)	0.035	0.851
Coronary disease/n(%)	2 (6.2)	10 (47.6)	12.389	<0.001
Brain infarction/n(%)	1 (3.1)	7 (33.3)	9.028	0.003
Hyperlipidemias/n(%)	3 (9.4)	12 (57.1)	14.257	<0.001
Lesion site/n(%)			0.212	0.899
Upper thoracic esophagus	6 (18.8)	4 (19.0)
Middle thoracic esophagus	15 (46.9)	11 (52.4)
Lower thoracic esophagus	11 (34.4)	6 (28.6)
Depth of invasion/n(%)			0.034	0.854
Mucosa	19 (59.4)	13 (61.9)
Submucosa	13 (40.6)	8 (38.1)
Postoperative pathology/n(%)			1.471	0.479
Low-grade intraepithelial neoplasia	11 (34.4)	4 (19.0)
High-grade intraepithelial neoplasia	15 (46.9)	12 (57.1)
Squamous cell carcinoma	6 (18.8)	5 (23.8)
Circumferential wound involvement/n(%)			0.121	0.727
≥3/4 of the circumference, <circumference	23 (71.9)	16 (76.2)
Circumference	9 (28.1)	5 (23.8)
Longitudinal length of the resected mucosa/mm	5.83±1.09	6.12±1.06	-0.984	0.330

Characteristic	Oral glucocorticoid group (n=32)	Oral glucocorticoid plus statin group (n=21)	t/χ² value	P value
Gender/n(%)			0.026	0.872
Male	19 (59.4)	12 (57.1)
Female	13 (40.6)	9 (42.9)
Age/year	61.88±7.53	64.95±9.18	-1.333	0.188
BMI/(kg·m^-2)	21.50±1.95	22.40±2.17	-1.579	0.121
Smoking/n(%)	15 (46.9)	15 (71.4)	3.112	0.078
Alcohol consumption/n(%)	14 (43.8)	14 (66.7)	2.672	0.102
Hypertension/n(%)	13 (40.6)	11 (52.4)	0.707	0.400
Diabetes mellitus/n(%)	4 (12.5)	3 (14.3)	0.035	0.851
Coronary disease/n(%)	2 (6.2)	10 (47.6)	12.389	<0.001
Brain infarction/n(%)	1 (3.1)	7 (33.3)	9.028	0.003
Hyperlipidemias/n(%)	3 (9.4)	12 (57.1)	14.257	<0.001
Lesion site/n(%)			0.212	0.899
Upper thoracic esophagus	6 (18.8)	4 (19.0)
Middle thoracic esophagus	15 (46.9)	11 (52.4)
Lower thoracic esophagus	11 (34.4)	6 (28.6)
Depth of invasion/n(%)			0.034	0.854
Mucosa	19 (59.4)	13 (61.9)
Submucosa	13 (40.6)	8 (38.1)
Postoperative pathology/n(%)			1.471	0.479
Low-grade intraepithelial neoplasia	11 (34.4)	4 (19.0)
High-grade intraepithelial neoplasia	15 (46.9)	12 (57.1)
Squamous cell carcinoma	6 (18.8)	5 (23.8)
Circumferential wound involvement/n(%)			0.121	0.727
≥3/4 of the circumference, <circumference	23 (71.9)	16 (76.2)
Circumference	9 (28.1)	5 (23.8)
Longitudinal length of the resected mucosa/mm	5.83±1.09	6.12±1.06	-0.984	0.330

Item	Oral glucocorticoid group		Oral glucocorticoid plus statin group		χ² value	P value
Item	Patient/n	Esophageal stricture/n(%)	Patient/n	Esophageal stricture/n(%)	χ² value	P value
Circumferential wound involvement	32	12 (37.5)	21	4 (19.0)	2.048	0.152
≥3/4 of the circumference, <circumference	23	4 (17.4)	16	1 (6.2)	1.048	0.306
Circumference	9	8 (88.9)	5	3 (60.0)	1.593	0.207

Item	Oral glucocorticoid group		Oral glucocorticoid plus statin group		χ² value	P value
Item	Patient/n	Esophageal stricture/n(%)	Patient/n	Esophageal stricture/n(%)	χ² value	P value
Circumferential wound involvement	32	12 (37.5)	21	4 (19.0)	2.048	0.152
≥3/4 of the circumference, <circumference	23	4 (17.4)	16	1 (6.2)	1.048	0.306
Circumference	9	8 (88.9)	5	3 (60.0)	1.593	0.207

Characteristic	OR (95% CI)	P value
Male	1.270 (0.381‒4.229)	0.697
Age	0.977 (0.909‒1.050)	0.524
BMI	1.009 (0.758‒1.343)	0.951
Smoking	0.682 (0.210‒2.218)	0.524
Drinking	0.850 (0.263‒2.750)	0.786
Hypertension	0.915 (0.281‒2.979)	0.883
Diabetes mellitus	1.904 (0.373‒9.705)	0.438
Coronary disease	0.718 (0.166‒3.100)	0.657
Brain infarction	0.729 (0.132‒4.123)	0.729
Hyperlipidemias	0.788 (0.208‒2.989)	0.726
Lesion site
Upper thoracic esophagus	1.000
Middle thoracic esophagus	1.778 (0.306‒10.324)	0.521
Lower thoracic esophagus	2.182 (0.346‒13.756)	0.406
Depth of submucosal invasion	0.880 (0.263‒2.940)	0.835
Postoperative pathology
Low-grade intraepithelial neoplasia	1.000
High-grade intraepithelial neoplasia	1.375 (0.340‒5.556)	0.655
Squamous cell carcinoma	1.031 (0.179‒5.948)	0.973
Circumferential wound involvement	24.933 (5.112‒121.609)	<0.001
Longitudinal length of the resected mucosa	1.187 (0.687‒2.053)	0.539
Use of statins	0.392 (0.107‒1.444)	0.159