PRISMA – Practical meta-analysis of applying local triamcinolone acetonide injection for stenosis after esophageal cancer surgery

Wu Wang,1 Zhen Shen,2 Baoxin Du,3 Yanyang Pang4 1Laboratory of Tropical Biomedicine and Biotechnology, School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan 570100, China; 2Division of Liver Disease, Huangshi City Hospital of Traditional Chinese Medicine (Infectious Disease Hospital), Edong Healthcare Group, Huangshi, Hubei 435000, China; 3Department of Urology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 402760, China; 4Department of Traditional Chinese Medicine, Hainan Medical University, Haikou, Hainan 570100, China Objectives: To explore the practical method of endoscopic triamcinolone acetonide (TA) injection immediately after endoscopic surgery and combined with endoscopic dilation (ED) in the management of stenosis after esophageal cancer surgery based on their efficacy and safety. Methods: A comprehensive search was performed in electronic databases including MEDLINE, EMBASE, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure for possible controlled studies. Meta-analyses of the included studies were completed using Reviewer Manager software and were reported based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: Eight randomized studies and five controlled studies containing 575 patients were obtained. In five studies (n=282), TA injected after surgery reduced the risk of stenosis (risk difference [RD] =–0.51, 95% CI [–0.64, –0.39], P<0.01) and the required ED sessions (RD =–3.66, 95% CI [–5.87, –1.46], P<0.01). In eight studies (n=293), TA injection combined with ED reduced the risk of recurrence of stenosis (RD =–0.28, 95% CI [–0.47, –0.08], P<0.01) and the required ED sessions (RD =–0.71, 95% CI [–1.39, –0.04], P<0.05). TA injection therapy did not increase the risk of complications in seven studies (n=380; RD =–0.01, 95% CI [–0.04, 0.02], P=0.53) compared with control. Conclusion: TA injection therapy after esophageal cancer surgery and combined with ED are both effective and safe in the management of stenosis, as they reduce the risk of stenosis and sequentially the required ED sessions without increasing complications. Keywords: stenosis, esophageal cancer, surgery, triamcinolone acetonide, meta-analyse