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Published on: May 14, 2013
Steroid pulse therapy prevents restenosis following balloon dilatation for esophageal stricture
Kazuki Yokota1, Hiroo Uchida2, Akihide Tanano1
1Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
Insights
Intravenous steroid pulse therapy combined with balloon dilatation effectively treats pediatric esophageal stenosis and strictures. This approach improved dysphagia symptoms and prevented recurrence in all patients, demonstrating a safe and effective treatment option.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Pharmacological Interventions
Background:
- Esophageal stenosis and strictures in children can result from congenital conditions or post-surgical complications.
- Conventional treatments like balloon dilatation may have limited long-term efficacy for certain types of esophageal strictures.
- Exploring adjunctive therapies to improve outcomes of endoscopic interventions is crucial.
Purpose of the Study:
- To assess the efficacy and safety of intravenous steroid pulse therapy in conjunction with balloon dilatation for pediatric esophageal stenosis and stricture.
- To evaluate the impact of this combined therapy on symptom resolution and recurrence rates.
Main Methods:
- A cohort of six pediatric patients with esophageal stenosis or strictures (three congenital, three anastomotic) were treated.
- Treatment involved balloon dilatation followed by a 4-day course of high-dose intravenous methylprednisolone pulse therapy.
- Dosage regimen: 20 mg/kg/day for 2 days, then 10 mg/kg/day for 2 days.
Main Results:
- Congenital esophageal stenosis patients experienced recurrence with balloon dilatation alone but improved with steroid pulse therapy.
- All three patients with anastomotic strictures showed symptom resolution following balloon dilatation and steroid pulse therapy.
- All six patients remained asymptomatic during a 6-21 month follow-up period with no reported complications.
Conclusions:
- Intravenous methylprednisolone pulse therapy following balloon dilatation is a safe and effective treatment for pediatric esophageal stenosis and strictures.
- This combined therapeutic approach offers a promising solution for managing challenging esophageal strictures in children.
- The study highlights the potential of systemic steroid therapy as an adjunct to endoscopic dilation in pediatric esophageal disease.
Purpose:
This study aimed to evaluate the effectiveness of intravenous steroid pulse therapy following balloon dilatation for esophageal stenosis and stricture in children.
Methods:
The study enrolled six children, including three with congenital esophageal stenosis and three with anastomotic strictures after surgery for esophageal atresia, all of whom were treated by balloon dilatation combined with high-dose intravenous methylprednisolone pulse therapy. Methylprednisolone was injected intravenously at a dose of 20 mg/kg/day for 2 days, starting from the day of dilatation, followed by 10 mg/kg/day for 2 days, for a total of 4 days.
Results:
Esophageal stricture recurred in all three patients with congenital esophageal stenosis despite repeated balloon dilatation without methylprednisolone. However, the symptoms of dysphagia improved and did not recur after systemic steroid pulse therapy following balloon dilatation. Symptoms also resolved in all three patients with anastomotic strictures following balloon dilatation with systemic steroid pulse therapy. All six patients remained asymptomatic after 6-21 months follow-up, with no complications.
Conclusion:
Intravenous methylprednisolone pulse therapy following balloon dilatation is safe and effective for the treatment of esophageal stenosis and strictures in children.
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