Do Steroid Injections Work for Esophagogastric Anastomotic Strictures?

David A. Johnson, MD

Apparently not. However, study treatment procedures might not reflect standard practices.

The clinical management of benign persistent anastomotic strictures of the esophagus is often challenging. Corticosteroid injection coupled with dilation has been shown to be effective in refractory peptic strictures, but does it work for anastomotic strictures?

In a multicenter, double-blind trial, 60 patients with solid-food dysphagia and an untreated cervical esophagogastric anastomotic stricture after esophagectomy were randomized to receive triamcinolone or saline injection. For mild strictures, dilation to 16 mm was usually achieved in a single endoscopy. For more severe strictures, ≥2 endoscopies within 1 week were performed. If dilation to 16 mm was deemed safe, 0.5-mL aliquots of triamcinolone (40 mg/mL) or saline were injected into the stricture in 4 quadrants, followed by Savary dilation to 16 mm. Patients received 40 mg omeprazole (or an equivalent proton-pump inhibitor) once daily during follow-up.

The number of dysphagia-free patients (without need for repeat dilation) after 6-months follow-up (primary endpoint) did not differ between groups. Secondary endpoints did not differ, including time to repeat dilation, total number of endoscopic dilations, intervention-related (major) complications, dysphagia scores, quality of life, or patients' satisfaction with the administered therapy. Four patients who received triamcinolone developed Candida esophagitis.

Citation(s):

Hirdes MMC et al. Endoscopic corticosteroid injections do not reduce dysphagia after endoscopic dilation therapy in patients with benign esophagogastric anastomotic strictures. Clin Gastroenterol Hepatol 2013 Jul; 11:795.