Effect of Oral Fluticasone on Refractory Peptic Esophageal Stricture - A New Therapeutic Method for Refractory Peptic Esophageal Stricture

Abstract

Purpose: Esophageal dilation is a safe and effective initial therapeutic option for the treatment of benign strictures of the esophagus. Intralesional steroid therapy, electrosurgical incision, or stent placement can be used for specific patients with refractory benign esophageal stricture. However, in some patients with refractory esophageal stricture, these therapeutic modalities may not be effective. The purpose of this study is to evaluate oral fluticasone inhaler as a therapeutic modality for management of refractory peptic esophageal stricture. Methods: Patients with refractory peptic esophageal stricture (after eosinophilic esophagitis were ruled out) were enrolled in this study. As EGD with intralesional steroid injection must be performed at intervals, we prescribed patients oral inhalation therapy with fluticasone for use between dilations and compared its effect with that of intralesional steroid injection on frequency of esophageal dilation. To avoid any possible bias, oral steroid inhaler was given alternatively at each session of esophageal dilation and intralesional steroid injection, as showed in this flow diagram: A__B__A__B__A__B__A___B__. (A: esophageal dilation + intralesional lesion steroid injection; B: esophageal dilation + intralesional lesion steroid injection + oral steroid inhaler). We analyzed the data from the first 6 sessions. Results: With dilation only, patients required subsequent dilation about once a month. When intralesional steroid injection was performed in addition to dilation, patients required dilations about every 2 months. Use of inhaled oral steroids significantly decreased the frequency of esophageal dilations (see Table). There were no side effects with the use of fluticasone during this period.Table: [54] Days elapsed between esophageal dilationsConclusion: Oral steroid inhaler therapy is more effective than intralesional steroid injection in augmenting the effect of esophageal dilation in patients with refractory peptic esophageal stricture. To our knowledge, this is the first report of using orally inhaled steroid in treatment of refractory peptic esophageal stricture. A multiple center study is needed to investigate this novel observation further.