Corticosteroids for Preventing Caustic Esophageal Strictures: Systematic Review and Meta-Analysis

ABSTRACT Objectives: Caustic ingestion can have a complicated clinical course. Corticosteroids are widely used but there is uncertainty about its role in preventing esophageal stricture formation following caustic ingestion. This systematic review and meta-analysis assessed the available clinical evidence regarding the efficacy and safety of corticosteroids for preventing esophageal strictures following caustic injury. Methods: We assessed randomized controlled trials (RCTs) that compared corticosteroids versus no corticosteroids in the prevention of esophageal stricture formation following caustic ingestion. We searched the following databases from inception to March 2017: PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Two reviewers retrieved eligible articles, assessed risk of bias, and performed data extraction. The main outcome measure was the prevention of esophageal stricture formation. Results: The search identified 763 citations. Three RCTs involving 244 participants met the inclusion criteria. There was no benefit of corticosteroids in the prevention of esophageal strictures following the ingestion of caustic materials (RR = 0.63, 95% CI = 0.29–1.37). Conclusions: The available evidence does not support the use of corticosteroids for the prevention of esophageal strictures following caustic ingestion. The overall quality of the evidence is limited due to methodological weaknesses and small sample sizes in the primary studies. Address correspondence and reprint requests to Professor Anthony K. Akobeng, Division of Pediatric Gastroenterology, Sidra Medical and Research Center, P O Box 26999, Doha, Qatar (e-mail: aakobeng@sidra.org). Received 19 October, 2017 Accepted 19 November, 2017 Conflict of interest and source funding: None declared Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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