Comparative study of oesophageal stricture balloon dilatation with and without triamcinolone 1% intralesional injection
Keywords:Balloon dilatation, Esophageal stricture, Triamcinolone
Background: The objective of the study was to effect of steroids in the long term outcome of esophageal benign stricture after endoscopic balloon dilation in terms of recurrence.
Methods: With purposive sampling, 50 cases were taken in these studies who were admitted with strictures at any location along the esophagus and of any size at New Civil Hospital, Surat. The indoor patients for a three year period were retrieved using a prepared case sheet proforma on the basis of the patient’s demographic profile and clinical findings. Patients had undergone endoscopic balloon dilation for esophageal benign stricture. In 25 patients endoscopic dilation was followed by submucosal injection of long-acting steroid triamcinolone and the remaining 25 patients were taken as a control.
Results: All patients have normal dietary intake including solid food at the time of discharge. All patients under study were regularly followed quarterly. Overall stricture recurrence can be reduced by intralesional triamcinolone injection providing stricture length <6 cm. Stricture >6 cm required a repeated procedure or other treatment modalities, In study group duration between endoscopic dilatation sessions fell significantly over a post dilatation period of 3 to 12 months.
Conclusions: In addition to endoscopic dilatation, intralesional trimicinolone injection is safe, effective and significantly decrease stricture rate and decrease endoscopic dilatation sessions.
Kim JH, Shin JH, Song HY. Benign strictures of the esophagus and gastric outlet: interventional management. Korean J Radiol. 2010;11(5):497-506.
Siersema PD, de Wijkerslooth LRH. Dilation of refractory benign Oesophageal strictures. Gastrointestinal Endoscopy. 2009;70(5):1000-12.
Classen M, Tytgat GNJ, Lightdale CJ. Gastroenterological Endoscopy 2nd Edition. Thieme. 2010: 496.
Classen M, Tytgat GNJ, Lightdale CJ. Gastroenterological Endoscopy 2nd Edition. Thieme. 2010: 323.
Robert HD, Management of the patient with benign Oesophageal stricture. Surg. Clin. North. Am. 1983;63:885-903.
Ketchum LD, Smith J, Robinson DW, Master FW. The treatment of hypertrophic scar, keloid and scar contracture by triamcinolon acetonide. Plast Reconstr Surg. 1977;11:169-72.
Kochhar R, Ray JD, Sriram PVJ, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive Oesophageal strictures. Gastrointest Endosc. 1999;49:509-13.
Mendelson HJ, Maloney WH. The treatment of benign strictures of the esophagus with cortisone injection. Ann Otol Rhino Laryngol. 1970;79:900-4.
Berenson GA, Wyllie R, Caulfield M, Steffen R. Intralesional steroids in the treatment of refractory Oesophageal strictures. J Pediatr Gastroenterol. 1994;18:250-2.
Altintas E, Kacar S, Tunc B, Sezgin O, Parlak E, Altiparmak E, et al. Intralesional steroid injection in benign Oesophageal strictures resistant to bougie dilation. J Gastroenterol Hepatol. 2004;19:1388-91.
Takahashi H, Arimura Y, Okahara S, Kodaira J, Hokari K, Tsukagoshi H, et al. A randomized controlled trial of endoscopic steroid injection for prophylaxis of Oesophageal stenoses after extensive endoscopic submucosal dissection. BMC Gastroenterol. 2015;15:1.
Schoepfer A. Treatment of eosinophilic esophagitis by dilation. Digestive Dis. 2014;32:130-3.
Hirdes MMC, van Hooft JE, Koornstra JJ. Endoscopic Corticosteroid injection do not reduce dysphagia after endoscopic dilatation therapy in patients with benign esophagogastric anastomotic stricture. Clin Gastroenterol Hepatol. 2013;11(7):795-801.
Haller JA Jr, Andrews HG, White JJ, Tamer MA, Cleveland WW. Pathophysiology and management of acute corrosive burns of the esophagus: results of treatment in 285 children. J Pediatr Surg. 1971;6(5):578-84.
O’neill JA, Betts J, Ziegler MM, Schnaufer L, Bishop HC, Templeton JM. Surgical management of reflux strictures of the esophagus in childhood. Annals of Surg. 1982;196(4):453-60.
Ashcraft KW, Holder TM. The experimental treatment of Oesophageal strictures by intralesional steroid injections. J Thoracic Cardiovascular Surg. 1969;58:685-91.
Holder TM, Ashcraft KW, Leape L. The treatment of patients with Oesophageal strictures by local steroid injections. J Pediatr Surg. 1969;4:646-53.
Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign Oesophageal strictures. Gastrointestinal Endoscopy, 2002;56:829-34.
Lee M, Kubik CM, Polhamus CD, Brady CE III, Kadakia SC. Preliminary experience with endoscopic intralesional steroid injection therapy for refractory upper gastrointestinal strictures, Gastrointestinal Endoscopy. 1995;41(6):598-601.