Evaluation of Steroid Injection in Conjunction with Endoscopic Dilation in Treatment of Refractory Esophagogastric Anastomotic Strictures

Abstract

Purpose: The purpose of this study is to evaluate the outcome of steroid injection along with endoscopic balloon dilation in the treatment of anastomotic strictures in post esophagectomy patients. Methods: A retrospective review of all patients who underwent esophagectomy for treatment of esophagogastric malignancy and developed a benign anastomotic stricture during the period of January 2002 to November 2010. Patients were treated by endoscopic balloon dilation. As adjuvant therapy, 80 mg of triamcinolone was injected in 3-4 quadrants into the stricture. Patients with recurrence of malignancy were excluded. Stricture size was estimated by the size of balloon used in initial dilation and final dilation. Total number of dilations, total number of dilations in which adjuvant steroid injection was used, initial stricture size, and final stricture size were obtained for analysis. Results: 23 patients underwent a total of 202 endoscopies and were included in the study. Steroid injection was utilized in 119 (59%) of these dilation sessions. The average stricture size at the first dilation was 9.69 ± 3.1 and average ending stricture size was 18.3 ± 2.5 (p<0.0001). No perforations or other major complications occurred. No patients required feeding tubes or revisional surgery. Conclusion: This retrospective review demonstrated a statistically significant increase in stricture size for steroid injections combined with balloon dilation for anastomotic strictures post-esophagectomy. These strictures were often refractory requiring multiple dilations and steroid injections. Satisfactory outcomes without complications were obtained with endoscopic therapy alone and salvage therapy was not required.