Issue: February 2021
Perspective from Amit Bhatt, MD
Disclosures: The authors report no relevant financial disclosures.
December 16, 2020
2 min read
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Topical budesonide may decrease endoscopic strictures after EMR, ESD

Issue: February 2021
Perspective from Amit Bhatt, MD
Disclosures: The authors report no relevant financial disclosures.
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Recent data showed that topical budesonide may be linked to a decrease in endoscopic strictures after endoscopic mucosal resection or endoscopic submucosal dissection.

“These results add to the existing literature and suggest the need for randomized control trials and larger sample sizes to further assess the impact of topical corticosteroids on the rate of stricture formation after wide-field mucosal resection in the esophagus,” Michael J. Bartel, MD, PhD, from the section of gastroenterology at the Fox Chase Cancer Center in Philadelphia, and colleagues wrote in Gastrointestinal Endoscopy.

Bartel and colleagues assigned 3 mg budesonide orally twice a day for 8 weeks to 25 patients who underwent esophageal endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of 50% or more esophageal circumference. These patients were matched with 75 patients who received no budesonide. The presence of endoscopic strictures at the 12-week follow-up served as the primary endpoint.

Results showed patients who received budesonide had a higher proportion of circumferential EMR.

“The proportion of patients with [endoscopic strictures] was not significantly lower in the budesonide cohort (16% vs 28%),” the researchers wrote.

According to logistic regression analysis, budesonide remained linked to lower incidences of endoscopic strictures (P = .023). However, when the baseline characteristic was controlled with a propensity score-weighted logistic regression model, there was no impact on endoscopic stricture formation (P = .176).

“[The] lack of statistical significance may be due to the small sample size, rather than to a null effect of budesonide,” the investigators wrote. “We caution against inferring that budesonide is not effective, particularly as budesonide application was associated with a lower rate of stricture formation in the multivariate analysis.”