Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures

Background: Intralesional corticosteroid injection has been shown to be eff ective in refractory esophageal strictures of various etiologies. The prese nt study was conducted to determine the efficacy of intralesional triamcino lone in augmenting results of endoscopic dilation in corrosive esophageal s trictures. Methods: Seventeen patients with corrosive esophageal strictures were treat ed with endoscopic dilation together with injection of triamcinolone aceton ide into the stricture. Fourteen patients were already undergoing dilation; 3 patients were newly recruited. The interval between dilations and freque ncy of dilation were calculated before and after corticosteroid injections, and periodic dilation index was calculated as number of dilations/number o f months. Results: The mean age of the 17 patients (8 men and 9 women) was 30 +/- 9.2 1 (range 13 to 52). Thirteen had strictures due to acid ingestion, four to alkali ingestion. There were 18 strictures in total, involving the upper (n = 2), middle (n = 10), and lower (n = 6) thirds of esophagus. Fourteen pat ients already on a dilation program had undergone 27.92 +/- 28.63 (range 6 to 92) dilations over a period of 22.92 +/- 30.73 months (range 2 to 96) be fore corticosteroid injections. Nine patients received a single injection o f triamcinolone, whereas four each had two and three sessions. The dilation requirement after injections in these 14 patients was reduced to 3.57 +/- 2.90 (range 0 to 10) dilations over a period of 10.5 +/- 5.58 (range 4 to 2 1) months.The median total periodic dilation index irrespective of corticos teroid therapy was 0.33 (range 0.55 to 1.8). In 12 of the 14 patients, peri odic dilation index before injections (range 0.91 to 3.0, median 1.67) was higher than the median total periodic dilation index and in all the 14 pati ents periodic dilation index after corticosteroid therapy (range 0 to 0.83, median 0.32) was less than the median of total periodic dilation index (p < 0.01). In addition three patients received intralesional corticosteroid i njections at the time of first dilation. These three patients could be effe ctively dilated with 5, 3, and 3 dilations. Conclusions: Intralesional triamcinolone injections augment the effects of endoscopic dilation in patients with corrosive esophageal strictures.