Safety and Efficacy of steroid injection with endoscopic dilatation in pediatric refractory benign esophageal stricture: a Clinical trials

doi:10.21203/rs.3.rs-4858384/v1

Background and Study Aim: While dilation therapy is the primary treatment for benign esophageal strictures, the recurrence or lack of responsiveness of strictures to this treatment can necessitate additional or repeated treatment. The objective of this study was to investigate the efficacy and safety of intralesional steroid injections (ISIs) in addition to dilation in patients with refractory benign esophageal strictures.

Methods: The clinical trial included 21 pediatric patients with refractory benign esophageal strictures. An upper gastrointestinal endoscopy was conducted to the level of the stricture, after which esophageal dilation was performed. Subsequently, endoscopy was repeated, and a steroid was injected intralesionally under direct endoscopic vision. The procedure's efficacy was evaluated over 12 months by assessing several parameters, including the number of dilatations, maximum dilator size, periodic dilatation index (PDI), and dysphagia score.

Results: The response to steroids was successful in 17 patients (81%) and unsuccessful in 4 patients (19%). The number of dilatations, PDI, and dysphagia score were significantly reduced following ISIs in comparison to pre-injection. Conversely, the maximum dilator size demonstrated a significant increase following ISIs compared to the pre-injection period. No side effects following steroid injections in children with esophageal strictures were reported in this study.

Conclusion: Endoscopic dilatation followed by steroid injection is a useful strategy for the treatment of refractory benign esophageal strictures.

Esophageal stricture

Steroid injection

Endoscopic dilatation

Benign esophageal strictures represent a significant challenge for gastroenterologists in clinical practice, frequently occurring after caustic ingestion or post-esophageal atresia repair [1]. As the majority of these strictures are characterized by cicatricial and fibrotic processes, their management has historically posed a significant challenge. However, 30–40% of these patients demonstrate inadequate responses even after repeated rigorous dilation, ultimately progressing to refractory benign esophageal strictures [2].

Endoscopic dilation alone is often insufficient, and supplementary treatment modalities can be used, including topical injections of steroids or mitomycin C, incisional therapy, stent placement, repetitive self-dilation, and surgery [3].

Intralesional steroid injections (ISIs) using triamcinolone acetonide, a synthetic corticosteroid with preventive effects on collagen synthesis, fibrosis, and chronic healing, were utilized. It is well established in keloid and burn-induced scars, where it prevents collagen deposition and enhances its breakdown, diminishing scar formation [4]. Their use in benign esophageal strictures was first tested in a canine model in 1969, which showed a significant improvement in the stricture after triamcinolone injection, compared to saline injection or no treatment [5].

The objective of this study was to evaluate the methodology, efficacy, and safety of ISIs in conjunction with upper endoscopic dilatation for the treatment of refractory benign esophageal strictures in children.

This prospective clinical trials study was conducted in the pediatric surgery departments of New Damietta and Cairo, Al-Azhar University Hospital, Egypt, between March 2022 and April 2024. The study was revised and approved by the ethics committee of Al-Azhar University, Egypt. IRP numbered 00012367-24-06-002, Clinical trial registration was completed and the number NCT05614079 was assigned. The parents or caregivers of the enrolled children were informed, and written consent was obtained from them while attending hospitals before participating in the study.

Patients eligible for the study were subjected to full history taking (including demographic data, history of exposure to corrosive material, or previous surgical operation) and clinical examination. Chest radiography, esophagography (Fig. 2A), and upper GI endoscopy were performed to diagnose the nature and extent of the esophageal stricture. Pediatric patients aged less than 14 years with refractory benign esophageal strictures who received dilatation therapy without triamcinolone injections were included. Patients with failure to pass a guidewire secondary to pharyngeal stenosis, and those who received triamcinolone injections at early dilatation were excluded from this study.

Description of the technique:

Under general anesthesia with the patient in the left lateral position. A single-channel endoscope was used. Endoscopic bougie dilatation was performed using a Wire-guided Polyvinyl dilator (Savary Gilliard/SG). The scope was introduced to evaluate the anatomy (Fig. 1A), and then the bougie dilator was passed over the metal guide wire. The first dilator was chosen based on the estimated diameter of the esophageal stricture. The sensation of resistance during dilatation on this dilator protects against over-dilatation [6]. To prevent adverse events, particularly perforation, we use the "Rule of Three" which means that the stricture is dilated no more than 3 mm per session using three consecutive bougies once moderate resistance is encountered [7].

After dilation, the endoscope was inserted (Fig. 1B) to evaluate the dilatation and complications such as bleeding or perforation. Long-acting steroid, triamcinolone acetonide, was injected via a 25-gauge sclerotherapy catheter. One mL of triamcinolone acetonide (40 mg/ml) was diluted with one mL saline in a 2 mL disposable syringe. 0.5 mL was injected at the proximal margin of the stricture in each quadrant (i.e., 2 mL of solution per stricture) (Fig. 1C). In patients with two strictures, injections were administered to both strictures.

By the end of the procedure, chest radiography was done to exclude perforation. Patients were then discharged when they were able to tolerate oral feeding. Patients were monitored for the incidence of early complications including persistent chest pain, fever, breathlessness, tachycardia, pulmonary aspiration, fistulas, or significant bleeding. Upon discharge, patients were instructed on the recommended diet regimen and the schedule for outpatient follow-up visits. Clinical evaluation and post-dilation esophagography were performed during postoperative visits (Fig. 2B).

Measurements and assessment regimen: -

The maximum dilator size, number of dilatations, periodic dilatation index (PDI), and dysphagia score were evaluated before and following the dilatation schedule. Maximum dilatation was determined through bougie dilatation, defined as the passage of the largest diameter of the bougie dilator. The number of dilatations indicated the number of dilatation sessions. PDI was calculated as the number of dilatations required, divided by the duration of time in months [8].

Dysphagia was graded into the following:

Score 0 - No dysphagia: able to eat a normal diet.
Score 1 - Moderate passage: able to eat some solid foods.
Score 2 - Poor passage: able to eat only semi-solid foods.
Score 3 - Very poor passage: able to swallow only liquids.
Score 4 - No passage: unable to swallow anything [9].

The success of dilatation was determined based on the resolution or alleviation of dysphagia, as well as the attainment of a diameter of 11 mm for patients aged < 2 years, 12 mm for patients aged between 2 and 5 years, and 15 mm for children aged > 5 years, with the complete cessation of symptoms without the necessity for endoscopic procedures or surgical intervention over at least 6 months. Unsuccessful dilatation was considered when an endoscope with a diameter of 5.9 mm could not be passed through, and the patient's dysphagia score exceeded 2. After treatment failure, additional endoscopic or surgical intervention was scheduled.

Statistical analysis

All statistical calculations were performed using the computer program SPSS (Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL, USA) version 20. Quantitative data were presented as the mean ± standard deviation (SD) for parametric data and as the median and range for non-parametric data. Qualitative data were expressed as frequencies and relative percentages. The Student's t-test was applied to evaluate the level of change within the group between pre-injection and post-injection dysphagia scores, total number of dilatations, PDI, and maximum dilatation achieved. A p-value of less than 0.05 was considered significant.

Twenty-one patients were enrolled during the study period; their ages ranged from 2 to 14 years, with a mean of 7.78 ± 3.85 years. Eleven patients (52.4%) were male, and 10 patients (47.6%) were female, and the mean disease duration was approximately 14 ± 6.35 months. Sixteen patients had a history of accidental ingestion of caustic (potash) and five patients had strictures after repair of esophageal atresia [Table 1].

Diagnostic endoscopy revealed a single stricture in 16 patients, two strictures in four patients, and three strictures in one patient with a mean stricture length of 1.78 ± 0.46 cm [Table 2].

Repeated dilation procedures were reduced from 9.33 ± 3.55 pre-intervention to 1.85 ± 1.79 post-intervention (P < 0.001). Pre-injection maximum dilator sizes were 9.0 ± 1.89 mm SG while post-injection maximum dilator sizes were 12.23 ± 2.11 mm SG with significant improvement (P < 0.001). PDI improved significantly from a pre-intervention score of 0.73 ± 0.34 to a post-intervention score of 0.30 ± 0.29 (P < 0.001). The dysphagia score also improved from a pre-intervention score of 3.42 ± 0.50 to a post-intervention score of 0.95 ± 0.35 (P < 0.001) [Table 3].

Successful improvement of both clinical and endoscopic findings was seen in 17 patients (81%), while unsuccessful improvement was seen in four patients with post-corrosive strictures (19%) [Table 2].

During 12 months of follow-up, none of our patients developed postoperative complications related to the procedures and/or steroid injection. Patients who did not improve were referred for surgical replacement.

Table (1): Baseline clinical data of the studied cases (n = 21)

Value

Age (years)

Mean± SD

Range

7.78±3.85

(2-14)

Sex

Male

Female

11 (52.4%)

10 (47.6%)

Duration (months)

Mean± SD

Range

14±6.35

(6-36)

Cause of stricture

Post-TEF repair

Corrosive

5 (23.8%)

16 (76.2%)

SD= Standard deviation

Table (2): Endoscopic and outcome data of the studied cases (n=21)

Value

Length of stricture (cm)

Mean± SD

Range

1.78±0.46

(1 – 2)

Number of strictures

1

2

3

16 (76.2%)

4 (19.0%)

1 (4.8%)

Outcome

Success

Failed

17 (81%)

4 (19%)

SD= Standard deviation

Table (3): Outcomes of ISIs of the studied cases (n=21)

	Mean SD	95% CI	test	P value
Number of dilatations
Pre-injection	9.33±3.55	7.0 - 12.0	8.622	<0.001
Post-injection	1.85±1.79	0.0 - 3.0	8.622	<0.001
Max dilator size
Pre-injection	9.00±1.89	7.0 - 11.0	5.225	<0.001
Post-injection	12.23±2.11	12.0 - 14.0	5.225	<0.001
Periodic dilatation index
Pre-injection	0.73±0.34	0.46 - 0.86	4.409	<0.001
Post-injection	0.30±0.29	0.0 - 0.50	4.409	<0.001
Dysphagia score
Pre-injection	3.42±0.50	3.0 - 4.0	7.862	<0.001
Post-injection	0.95±0.35	0.0 - 1.0	7.862	<0.001

SD= Standard deviation, CI= Confidence interval

Repeated dilatation sessions required in refractory benign esophageal strictures can be explained by intense fibrogenesis during healing and after the traumatic dilatation procedure. This necessitates repeated dilatations with an increased risk of complications and perforation [10]. Therefore, the injection of steroids at the site of a stricture at the time of dilatation is an attractive mechanism to reduce collagen deposition and fibrosis associated with repeated dilatation, thereby reducing the likelihood of stricture recurrence [1].

To determine whether dilation in combination with intralesional steroid injections is superior to dilation alone, several outcome parameters were used to assess treatment efficacy. The most commonly used parameter was the total number of dilations. The periodic dilation index (PDI) allows for a more consistent assessment of the frequency of dilation, as follow-up time can vary widely from study to study. Many other parameters have been used in different studies, such as maximum achieved diameter, dysphagia score with different scoring systems, and time to first repeat dilation. To assess the safety of the treatment, all minor or major complications resulting from dilation and/or ISIs were recorded [4].

Some authors prefer to inject corticosteroids before dilatation [11–14]. Injection of corticosteroids after dilatation specifically targets sites adjacent to or at the edge of wall tears to reduce the inflammatory and recurrent cicatricial response at the stricture site [15]. Consistent with our study, a recent randomized, blinded trial of 65 patients with postsurgical anastomotic strictures using triamcinolone injection directly after dilatation demonstrated a significant reduction in the number of dilatations (2.0 versus 4.0) and improvement in dysphagia within 6 months (39% versus 16%), suggesting that injection into the disrupted mucosa may have a greater effect on collagen deposition and stricture recurrence [3]. Other studies have also used corticosteroid injection after dilatation [15–20].

The concentration of triamcinolone acetonide used in this study was 40 mg/mL. Only a few previous studies have used this concentration [8, 21], while the others have used 10 mg/mL [16, 22, 23]. It is not yet clear what the optimal dose and repeat schedule are because, on the one hand, some studies have shown a beneficial effect of injections with low doses of triamcinolone [8, 18, 19]; on the other hand, high doses did not always lead to success [11, 14].

In the current study, the maximum dilation was 9.0 ± 1.89 mm SG preintervention and improved significantly to 12.23 ± 2.11 mm SG postintervention (P < 0.001). PDI improved significantly from a preintervention score of 0.73 ± 0.34 to a postintervention score of 0.30 ± 0.29 (P < 0.001). Dysphagia score also improved from 3.42 ± 0.50 preintervention to 0.95 ± 0.35 postintervention (P < 0.001). Kochhar et al [21] reported comparable results. They found a significant improvement in maximum dilator size, PDI, and dysphagia after ISIs in all etiologic categories. In their study, the maximum possible dilation was 11–15 mm SG before injection and 15–17 mm SG after injection. The PDI decreased from 1.24 ± 0.5 to 0.53 ± 0.34 (P < 0.001), while the dysphagia score decreased from 2.34 ± 0.55 to 0.65 ± 0.61 (P = 0.001).

The dysphagia score improved from 3.54 ± 0.52 pre-intervention to 0.45 ± 0.52 post-intervention (P < 0.001) in the study by Nijhawan et al [13]. The maximum dilation achieved before the intervention was 9.90 ± 1.04 mm SG and improved significantly to 14.7 ± 0.7 mm SG after the intervention (P < 0.001). The periodic dilation index also improved significantly from a preintervention value of 2.54 ± 1.06 to a postintervention value of 0.19 ± 0.13 (P < 0.001). Consistent with the results of this study, Narang et al [24] concluded that ISIs for refractory esophageal stricture after acid ingestion were effective in reducing the mean dysphagia score from 2.64 to 0.81 and the mean number of dilations required before and after steroid injection.

In the current study, the number of dilation procedures was significantly reduced from 9.33 ± 3.55 pre-intervention to 1.85 ± 1.79 post-intervention (P < 0.001). Although Orive-Calzada et al [14] reported an improvement in dilation size and a lower dysphagia score, they did not observe a significant effect of ISIs on the number of dilations.

In this study, successful improvement of both clinical and endoscopic findings was observed in 17 patients (81%), while unsuccessful improvement was observed in 4 patients (19%). Compared to the current findings, only a few studies have reported the outcomes of treatment with ISIs concerning different etiologies of strictures. Kochhar et al [8] and Nijhawan et al [13] showed significant improvement in caustic strictures. Hirdes et al [11] reported no benefit from the combined treatment of anastomotic strictures.

There was a wide variation in the modalities of steroid injections in terms of dose, injection schedule, and injection site. The dose per session ranged from 20 to 112 mg of triamcinolone [16, 19]. In some studies, the injections were repeated in case of re-dilation [8, 11, 12, 13, 15, 16, 19, 20, 21], while in others this was not the case [14, 18]. Only one study reported complications related to steroid injections, four cases of Candida esophagitis. They used 80 mg, a relatively high dose of triamcinolone, per session, which was repeated up to three times. This suggests that caution should be exercised when using higher doses of triamcinolone [11].

The 12-month follow-up of our patients showed no complications related to the procedures or the steroid injection, and none required discontinuation of this form of therapy. It is important to note that all studies reported a low number of complications; therefore, this technique appears to be safe. Similar to the current findings, several authors reported no associated complications [12, 13, 15, 16, 20, 21]. Only one minor complication occurred as a result of ISIs, with the formation of a bleb after submucosal injection and a temporary increase in dysphagia [8]. Altintas et al [18] reported two perforations, one in the dilatation-only group and one in the combined treatment group, both in caustic strictures. Hirdes et al [11] reported one gastrointestinal bleeding in the monotherapy group and 5 complications (1 laceration and 4 candida esophagitis) in the patients treated with ISIs. In the study by Orive-Calzada et al [14], one perforation occurred in the dilatation-only group and no complications were reported in patients treated with ISIs.

The limitations of the study were that it was a cohort study with a small number of patients, due to the marked reduction in the incidence of corrosive swallowing in pediatrics and the low incidence of postoperative stricture in esophageal atresia anomalies. A follow-up of only 12 months was also considered a limitation of the study.

Topical steroid injection combined with endoscopic dilatation is a safe and effective therapy for refractory benign esophageal strictures, indicating the efficacy of ISIs in minimizing the need for recurrent dilations. Furthermore, the maximal dilator size, periodic dilation index, and dysphagia score all showed considerable improvements.

Institutional Reviewer Board Approval:

The study protocol was approved by the Ethics Committee of the Faculty of Medicine at Al-Azhar University. This study was approved by the institutional review board. No. (IRB 00012367-24-06-002). The clinical Trial registration was performed (NCT05614079).

Ethical approval consent for participation: -

Written informed consent was obtained from all the parents. This study was approved by the Ethics Committee of our University Hospital. (Al-Azhar University, Faculty of Medicine).

Consent for publication: -

Written informed consent was obtained from the parents for participation and publication of the study.

Availability of data and material: -

The datasets used and/or analyzed during the current study are available from the corresponding author but could not be sent owing to the medicolegal aspect of the hospital policy.

Funding:

None.

Authors contribution: -

Study conception and design: Mohamed Anwar and Ahmed Abel-Aziz.

Data acquisition: Mohamed Shahin and Mohammad Daboos.

Analysis and data interpretation: Sayed Elhady and Ahmed Azab, Mohamed Magid.

Drafting of the manuscript: Mohamed Anwar, Sayed Elhady and Mohammad Daboos.

Critical revision: Mohammad Daboos, Mohamed Anwar, Mohamed Magid

Acknowledgments: -

We acknowledge all pediatric surgical teams at Al-Azhar University Hospital for their great efforts with the patients included in the study.

Conflicts of interest:

The authors declare no conflict of interest or financial disclosures.

Everett SM. Endoscopic management of refractory benign oesophageal strictures. Ther Adv Gastrointest Endosc. 2019 Aug 19;12:2631774519862134. doi: 10.1177/2631774519862134. PMID: 31460518; PMCID: PMC6702770.
Li L, Xu N, Wang P, Liu L, Gong W, Bi Y, et al. A novel self-inflatable balloon for treating refractory benign esophageal strictures: a prospective, single-arm, multicenter study. Int J Surg. 2024 Apr 1;110(4):2055-2064. doi: 10.1097/JS9.0000000000001120. PMID: 38668658; PMCID: PMC11020001.
Hanaoka N, Ishihara R, Motoori M, Takeuchi Y, Uedo N, Matsuura N, et al. Endoscopic Balloon Dilation Followed By Intralesional Steroid Injection for Anastomotic Strictures After Esophagectomy: A Randomized Controlled Trial. Am J Gastroenterol. 2018 Oct;113(10):1468-1474. doi: 10.1038/s41395-018-0253-y. Epub 2018 Sep 4. PMID: 30181533.
Henskens N, Wauters L, Vanuytsel T. Intralesional steroid injections in addition to endoscopic dilation in benign refractory esophageal strictures: a systematic review. Acta Gastroenterol Belg. 2020 Jul-Sep;83(3):432-440. PMID: 33094591.
Ashcraft KW, Holder TM. The expeimental treatment of esophageal strictures by intralesional steroid injections. J Thorac Cardiovasc Surg. 1969 Nov;58(5):685-91 passim. PMID: 5348158.
Methasate A, Lohsiriwat V. Role of endoscopy in caustic injury of the esophagus. World J Gastrointest Endosc. 2018 Oct 16;10(10):274-282. doi: 10.4253/wjge.v10.i10.274. PMID: 30364838; PMCID: PMC6198306.
Fugazza A, Repici A. Endoscopic Management of Refractory Benign Esophageal Strictures. Dysphagia. 2021 Jun;36(3):504-516. doi: 10.1007/s00455-021-10270-y. Epub 2021 Mar 12. PMID: 33710389.
Kochhar R, Ray JD, Sriram PV, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointest Endosc. 1999 Apr;49(4 Pt 1):509-13. doi: 10.1016/s0016-5107(99)70052-0. PMID: 10202068.
Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med. 1993 Oct 28;329(18):1302-7. doi: 10.1056/NEJM199310283291803. PMID: 7692297.
Liang D. Intermittent endoscopic dilation - A new method to prevent restenosis after benign esophageal stricture incision. Gastrointest Endosc. 2024; 2 (3): 103-6. ISSN 2949-7523, https://doi.org/10.1016/j.gande.2024.02.002.
Hirdes MM, van Hooft JE, Koornstra JJ, Timmer R, Leenders M, Weersma RK, 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(7):795-801.e1. doi: 10.1016/j.cgh.2013.01.016. Epub 2013 Jan 30. PMID: 23376318.
Ramage JI Jr, Rumalla A, Baron TH, Pochron NL, Zinsmeister AR, Murray JA, et al. A prospective, randomized, double-blind, placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures. Am J Gastroenterol. 2005 Nov;100(11):2419-25. doi: 10.1111/j.1572-0241.2005.00331.x. PMID: 16279894.
Nijhawan S, Udawat HP, Nagar P. Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion. Dis Esophagus. 2016 Nov;29(8):1027-1031. doi: 10.1111/dote.12438. Epub 2015 Nov 6. PMID: 26542391.
Orive-Calzada A, Bernal-Martinez A, Navajas-Laboa M, Torres-Burgos S, Aguirresarobe M, Lorenzo-Morote M, et al. Efficacy of intralesional corticosteroid injection in endoscopic treatment of esophageal strictures. Surg Laparosc Endosc Percutan Tech. 2012 Dec;22(6):518-22. doi: 10.1097/SLE.0b013e3182747b31. PMID: 23238379.
Pereira-Lima JC, Lemos Bonotto M, Hahn GD, Watte G, Lopes CV, dos Santos CE, et al. A prospective randomized trial of intralesional triamcinolone injections after endoscopic dilation for complex esophagogastric anastomotic strictures: steroid injection after endoscopic dilation. Surg Endosc. 2015 May;29(5):1156-60. doi: 10.1007/s00464-014-3781-6. Epub 2014 Aug 30. PMID: 25171883.
Lee M, Kubik CM, Polhamus CD, Brady CE, Kadakia SC. Preliminary experience with endoscopic intralesional steroid injection therapy for refractory upper gastrointestinal strictures. Gastrointest Endosc. 1995 Jun;41(6):598-601. doi: 10.1016/s0016-5107(95)70199-0. PMID: 7672557.
Miyashita M, Onda M, Okawa K, Matsutani T, Yoshiyuki T, Sasajima K, et al. Endoscopic dexamethasone injection following balloon dilatation of anastomotic stricture after esophagogastrostomy. Am J Surg. 1997 Oct;174(4):442-4. doi: 10.1016/s0002-9610(97)00116-5. PMID: 9337171.
Altintas E, Kacar S, Tunc B, Sezgin O, Parlak E, Altiparmak E, et al. Intralesional steroid injection in benign esophageal strictures resistant to bougie dilation. J Gastroenterol Hepatol. 2004 Dec;19(12):1388-91. doi: 10.1111/j.1440-1746.2004.03491.x. PMID: 15610312.
Kirsch M, Blue M, Desai RK, Sivak MV Jr. Intralesional steroid injections for peptic esophageal strictures. Gastrointest Endosc. 1991 Mar-Apr;37(2):180-2. doi: 10.1016/s0016-5107(91)70681-0. PMID: 2032604.
Ahn Y, Coomarasamy C, Ogra R. Efficacy of intralesional triamcinolone injections for benign refractory oesophageal strictures at Counties Manukau Health, New Zealand. N Z Med J. 2015 Jun 12;128(1416):44-50. PMID: 26117675.
Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointest Endosc. 2002 Dec;56(6):829-34. doi: 10.1067/mge.2002.129871. PMID: 12447293.
Zein NN, Greseth JM, Perrault J. Endoscopic intralesional steroid injections in the management of refractory esophageal strictures. Gastrointest Endosc. 1995 Jun;41(6):596-8. doi: 10.1016/s0016-5107(95)70198-2. PMID: 7672556.
Morikawa N, Honna T, Kuroda T, Watanabe K, Tanaka H, Takayasu H, et al. High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone. Pediatr Surg Int. 2008 Oct;24(10):1161-4. doi: 10.1007/s00383-008-2224-7. PMID: 18704454.
Narang S, Kansal S, Bherwani S, Shetty S, Vyas KY. Effect of Intralesional Triamcinolone Injection in Patients of Esophageal Stricture Post Acid Ingestion. J Den Med Sci., 2017; 16(3): 91-94. e-ISSN: 2279-0853, p-ISSN: 2279-0861.

No competing interests reported.

Safety and Efficacy of steroid injection with endoscopic dilatation in pediatric refractory benign esophageal stricture: a Clinical trials

Status:

Version 1

Abstract

Figures

Introduction

Patients and Methods

Description of the technique:

Measurements and assessment regimen: -

Dysphagia was graded into the following:

Statistical analysis

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1