Utilization of intralesional steroid injections in difficult esophageal strictures

F. D. Wright, L. P. Davis, J. G. Hunter, J. P. Waring

Research output: Contribution to journalArticle

Abstract

INTRO: Intralesional steroid injection USD appears to improve dysphagia and decrease the need for repeated dilation in patients with refractory esophageal strictures. However, it is not clear how many dilation/injection sessions are required. AIM: To determine the number of ISI sessions required to achieve a satisfactory outcome with esophageal dilation. METHODS: Our protocol for patients with esophageal strictures is to gradually dilate the esophagus to 45-54 F during repeated dilation sessions. Once achieving this goal, dilations are performed on a PRN basis. GERD is always treated with intensive medical therapy. Patients not responding after 2-3 dilation sessions receive ISI. A total of 45mg of triamcinolone is injected at each session, following the dilation. Patients undergo 2-3 sessions of esophageal dilation with ISI. It is then repeated if needed to maintain patency of the esophageal lumen. We reviewed the data regarding the dilation sessions on all patients receiving ISI. RESULTS: 318 patients had 901 dilations at Emory University Hospital from 1/95 to 12/97. 26 patients received 90 sessions of ISI. All patients improved. Only 6/26 patients still required dilation sessions more often than every 6 months. The mean esophageal lumen diameter at the initial session was 7.4 mm. The mean final dilator size was 47 Fr. Comparison of ISI requirements based on stricture etiology is seen in the table. Mean # ISI sessions Dilation frequency >6 mos GERD (n = 14) 2.9 1/14 Anastomotic (n = 7) 7.1 3/7 Other (n = 6) 2.0 2/5 18/26 patients received 3 or fewer ISI sessions. Of patients requiring 4 or more ISI sessions, 4 had anastomotic strictures, 4 had GERD. Three patients had surgery (2 fundoplication, 1 pyloroplasty). No patient required surgical resection of the esophagus. CONCLUSION: 1) ISI is rarely necessary. 2) Two to three ISI sessions will decrease dilation requirements in nearly all patients with refractory strictures. 3) Some patients, particularly those with refractory surgical anastomotic strictures, may require multiple ISI sessions for a satisfactory result.

Original languageEnglish (US)
Pages (from-to)AB78
JournalGastrointestinal endoscopy
Volume47
Issue number4
StatePublished - Dec 1 1998

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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