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Steroid injection helps prevent strictures after esophageal dilation
A steroid injection immediately after endoscopic balloon dilation helped patients avoid refractory esophageal strictures, according to research published in the American Journal of Gastroenterology.
Noboru Hanaoka, MD, of the department of gastroenterology at Osaka Red Cross Hospital in Japan, and colleagues wrote that anastomotic strictures are significant complications for patients after esophagectomy.
“Anastomotic stricture substantially decreases the patient’s quality of life, and requires treatment with esophageal dilation,” they wrote. “Refractory strictures occur in select patients, and these patients require repeated dilations.”
To test the efficacy of adding steroid injection to endoscopic balloon dilation (EBD), Hanaoka and colleagues conducted a randomized controlled trial that comprised 65 patients with a dysphasia symptom score of at least 2 after esophagectomy and a confirmed anastomotic stricture.
During the 4-year trial, investigators randomly assigned patients to undergo EBD combined with either 50 mg/mL triamcinolone (n = 33) or an equal amount of normal saline solution (n = 32).
In assessing the primary endpoint, Hanaoka and colleagues found that the median number of EBDs required to resolve strictures was lower in the steroid group (2; interquartile range, 1-2.5) compared with the placebo group (4; interquartile range, 2-6.8; P < .001).
After 6 months of follow-up, 39% of patients in the steroid group remained recurrence-free compared with 16% of patients in the control group (P = .002).
Hanaoka and colleagues wrote that EBD followed by steroid injection is a promising technique for initial treatment of patients with anastomotic stricture after esophagectomy.
“Dilation is the first-line treatment for benign esophageal strictures, including anastomotic strictures after esophagectomy, and the dilation then causes lacerations that gradually heal and cause restricture with fibrosis,” the researchers wrote. “Instead of performing steroid injection before dilation, we targeted all visible lacerations after EBD, as we hypothesized that the steroid would be more effective if it was injected into the laceration site immediately after EBD.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.