Intrastricture steroids improve esophageal stricture outcomes.
In a randomized, placebo-controlled study of 120 patients, intrastricture Kenalog injections significantly reduced the number of dilations needed to achieve a successful outcome by an average of about three, when compared with sham injections (4 vs. 7 dilations). This reduced the number of days lost from work by patients in the steroid group, and also improved quality of life as measured in terms of dysphagia, the ability to take pills, and effects on diet, said Dr. Mullick of Delnor-Community Hospital, Geneva, Ill.
The findings represent a major advancement in the treatment of complex esophageal strictures caused by acid-peptic disease, but steroid injections should be reserved only for those strictures smaller than 13 mm in size, he said.
In this study, 40 of 60 patients in the steroid group and 45 of 60 in the sham injection group had strictures smaller than 13 mm, and the therapeutic benefit of the steroid injections was entirely limited to these strictures.
Significantly fewer patients in the steroid group than in the sham injection group failed to achieve a successful outcome (0/60 vs. 9/60), which was defined as dilation of at least 18 mm. Failure to progress to the next size dilator occurred 2 times in the steroid group, compared with 132 times in the sham injection group; this difference was also statistically significant.
The steroid and sham injection groups were similar in terms of demographics, and all patients in both groups were treated with a proton pump inhibitor and underwent gradual dilation of the stricture using fluoroscopically-assisted balloon dilation over a guidewire every 4-6 weeks.
BY SHARON WORCESTER