Local injection of depot-corticosteroids for endoscopic therapy of benign biliary strictures

Background: Local injection of depot-corticosteroids into to benign esophag eal strictures has been proven to maintain the effects of bougienage or bal loon dilation. Methods: Eight consecutive patients with benign common bile duct (CBD)-stri ctures (postoperative. n = 6. primary-sclerosing cholangitis, n = 2) were e nrolled in this pilot trial. All had undergone initial balloon dilation and insertion of a 10F-plastic prostheses without relevant effects on the stri cture diameter four to six weeks before. Than all patients underwent another balloon dilation and insertion of a 10F -Tannenbaum-stent. In the same session injection of 2 x 10 mg of triamcinol one (Volon A, Bristol-Myers Squibb, Munchen) into the CBD-wall at the stric ture site by means of a sclerotherapy needle was performed. Four to six wee ks later ERC was repeated and balloon dilation and/or stent exchange was pe rformed whenever indicated. Results: The initial mean diameter of the CBD-stenoses was 1.81 +/- 0.65 mm , The mean serum levels of the alkaline phosphatase (AP) and of bilirubin w ere 455 +/- 188 U/L and 4.9 +/- 2.2 mg/dl, respectively After the initial b alloon dilation and stent insertion no significant improvement had bt en re gistered (1.9 +/- 0.7 mm). However, after local triamcinolone injection and the second dilation/stent insertion the diameter of the CBD-stenosis incre ased significantly to 3.68 +/- 0.96 mm (p < 0.01). No adverse affects were recognized. Three patients had complete recovery of their CBD-stenosis afte r a third dilation, the remaining five patients were cured after two or thr ee additional balloon dilations with intermittent stent exchange. Thereafte r, no recurrence of a CBD-stenosis was observed during a median follow-up o f twelve months. At completion of the study the mean serum AP- and bilirubi n level were 195 +/- 87 U/L and 1.2 +/- 0.4 mg/dl, respectively, Conclusion: Local application of depot corticosteroids is a feasible and sa fe procedure for therapy of benign CBD-stenoses. The results of this pilot trial justify a randomized study.