A prospective randomized trial of intralesional triamcinolone injections after endoscopic dilation for complex esophagogastric anastomotic strictures: steroid injection after endoscopic dilation.

Abstract

Postoperative esophageal strictures frequently recur. We assessed the efficacy of injecting triamcinolone after bougie dilation in comparison to dilation alone. In a double-blind randomized fashion, 19 patients (68% male with mean age of 53-years old) with non-dilated esophagogastric complex strictures after esophagectomy with gastric pull-up were assigned to receive dilation alone (control) or 40 mg of triamcinolone at the borders of the wall lacerations caused by the bougienage in each dilation session during the study follow-up. Dysphagia and complications were assessed at 1, 2, and 6 months. Primary end-point was to be dysphagia-free. After 1 month of the beginning of therapy, 4 patients in the steroid group were without dysphagia, in comparison to 0 patient in the control group (P = 0.021). Six months after endoscopic therapy, 62% of the cases in the triamcinolone group versus none in the control group were dysphagia-free (P = 0.009). There was no perforation nor hemorrhage. Injecting triamcinolone after every dilation session next to or at the borders of the lacerations caused by the dilators, results in a significant improvement or resolution of dysphagia.