Lokale Injektion von Depotkortikosteroiden bei der endoskopischen Therapie benigner Gallengangsstrikturen*

Abstract

Local injection of depot-corticosteroids into benign esophageal strictures has been proven to maintain the effects of bougienage or balloon dilation. Eight consecutive patients with benign common bile duct (CBD)-strictures (postoperative, n = 6, primary-sclerosing cholangitis, n = 2) were enrolled in this pilot trial. All had undergone initial balloon dilation and insertion of a 10F-plastic prostheses without relevant effects on the stricture 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 triamcinolone (Volon A, Bristol-Myers Squibb, München) into the CBD-wall at the stricture site by means of a sclerotherapy needle was performed. Four to six weeks later ERC was repeated and balloon dilation and/or stent exchange was performed whenever indicated. 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 were 455 +/- 188 U/L and 4.9 +/- 2.2 mg/dl, respectively. After the initial balloon dilation and stent insertion no significant improvement had been registered (1.9 +/- 0.7 mm). However, after local triamcinolone injection and the second dilation/stent insertion the diameter of the CBD-stenosis increased significantly to 3.68 +/- 0.96 mm (p < 0.01). No adverse affects were recognized. Three patients had complete recovery of their CBD-stenosis after a third dilation, the remaining five patients were cured after two or three additional balloon dilations with intermittent stent exchange. Thereafter, no recurrence of a CBD-stenosis was observed during a median follow-up of twelve months. At completion of the study the mean serum AP- and bilirubin level were 195 +/- 87 U/L and 1.2 +/- 0.4 mg/dl, respectively. Local application of depot corticosteroids is a feasible and safe procedure for therapy of benign CBD-stenoses. The results of this pilot trial justify a randomized study.