Endoscopic esophageal bougienage followed by modified intralesional steroid injection for refractory benign esophageal stricture: A retrospective study and meta-analysis

To evaluate the efficacy and safety of a modified intralesional steroid injection technique following bougienage in patients with Refractory Benign Esophageal Strictures (RBES).

Thirty patients with RBES were retrospectively enrolled at Peking University First Hospital between January 2012 and December 2021. All patients were treated with either endoscopic esophageal bougienage followed by modified intralesional steroid injections (using a 3 mm needle to target the submucosa at the edges of the dilation-induced mucosal tear) (n = 11) or endoscopic esophageal bougienage alone (n = 19).

There were no significant differences in the time to first repeat dilation between the combined therapy and bougienage-alone groups (Hazard Ratio [HR = 0.27], 95% CI 0.03 to 2.22; p = 0.189). Moreover, the authors the authors did not find a significant difference between the groups in the number of dilation sessions required (p = 0.107). In contrast, combined therapy was associated with a significantly shorter overall duration of dilation therapy (p = 0.043) and improved dysphagia severity (p = 0.044). Finally, there were no significant differences in the risks of delayed hemorrhage (p = 0.231) and perforation (p = 0.231) between the groups. Additionally, a meta-analysis of six existing studies confirmed that the combined approach was associated with significantly fewer required dilation sessions (p = 0.005) and a higher rate of dysphagia resolution (p = 0.021).

In this small, likely underpowered, retrospective cohort, modified combined therapy did not significantly prolong the time to first repeat dilation. Observations of a shorter total duration of dilation therapy and improved dysphagia severity are considered exploratory and hypothesis-generating. The pooled evidence from our meta-analysis supports the rationale for further investigation of steroid augmentation.