DOZ047.68: Intralesional steroid injection therapy for the treatment of esophageal anastomotic stricture in a pediatric esophageal atresia population

Abstract

Abstract Background and Aims The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in esophageal atresia (EA) patients remains unclear. The aim of this study is to evaluate the efficacy and safety of ISI in a large pediatric EA population. Methods One-hundred fifty eight EA patients who had undergone at least one ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with balloon dilation alone (ISI-) and balloon dilation with steroid injection (ISI+). Assessment for change in efficacy with increasing numbers of ISI interventions was performed. Results A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the group of steroid injection procedures: 1 mm (IQR 0, 3) versus 0 mm (IQR -1, 1.5) (P < 0.0001). The ISI+ group had greater percentage of improved stricture diameter (P < 0.0001) and lesser percentages of unchanged and decreased stricture diameters at subsequent endoscopy (P = 0.0009, P = 0.003). The ΔD for each of an anastomosis’ first 3 ISI+ procedures was greater than the ΔD for its subsequent ISI+ procedures: 1 mm (IQR 0, 3) versus 0.5 mm (IQR -1.25, 2) (P = 0.001). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter. Conclusions This study demonstrates that intralesional steroid injection with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first three ISI procedures.