Intralesional steroid injection in benign esophageal strictures resistant to bougie dilation

Some benign esophageal strictures are highly resistant to bougie dilation. The aim of this study was to determine whether intralesional steroid injection had additional benefit to Savary-Gilliard's bougie dilation therapy (SGBD).

Twenty-one patients were treated with a bougie dilator. The patients were randomized into control and study groups. There were 11 patients in the control group (7 males, 4 females; mean age 45.09 +/- 24.64 years) and 10 patients in the study group (4 males, 6 females; mean age 49.40 +/- 16.49 years). The patients in the control group underwent only SGBD, but patients in the study group received an additional intralesional steroid injection (8 mg triamcinolone acetate into each quadrant). The number of dilations was divided by the follow-up period (in months) to determine the periodic dilatation index.

There was no difference in age, sex, etiology, localization and recurrence of lesions, treatment outcome, complications and the number of dilations between the study and control groups. In the study group, the mean periodic dilatation index was 0.712 (range 0.097-2.75) and 0.289 (range 0-1) before and after injections, respectively (P = 0.03). Additionally, the mean number of dilations was 5.3 (range 2-11) and 1.6 (range 0-5) before and after injections, respectively (P = 0.03). The mean symptom-free interval was 24 +/- 12.75 months in the study group and 5.18 +/- 5.06 months in the control group (P < 0.001). The total periodic dilatation index was 0.193 +/- 0.123 in the study group, while it was 0.597 +/- 0.583 in the control group (P < 0.05).

It can be concluded that intralesional steroid injections increase efficacy of bougie dilation and decrease the requirement for repetition of bougie dilatation.