Endoscopic dexamethasone injection following balloon dilatation of anastomotic stricture after esophagogastrostomy

Miyashita, Masao; Onda, Masahiko; Okawa, Keiichi; Matsutani, Takeshi; Yoshiyuki, Toshiro; Sumii, Koji; Kudoh, Shoji; Yamashita, Kiyohiko

doi:10.1016/s0002-9610(97)00116-5

Cited by 56 publications

(41 citation statements)

References 3 publications

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“…In 1989, Gandhi [3] demonstrated that esophageal dilation with intralesional steroid injection succeeded in resolving severe esophageal strictures in 12 infants with esophageal atresia or corrosive esophagitis. Miyashita [9] has also reported that endoscopic dexamethasone injection (2 mg/0.5 ml into each quadrant) following balloon dilation was safe and effective for 11 adult patients with postoperative esophageal anastomotic stricture. Based on these reports, we performed the same intralesional steroid injection protocol as that of Miyashita in two cases with recalcitrant esophageal strictures.…”

Section: Discussionmentioning

confidence: 97%

“…One is to reduce the collagen content of the tissue by way of both decreasing prolyl hydroxylase activity and amplifying collagenase activity, and the other is antiinflammation activity [15]. Because it has been reported that histological observation of the strictures revealed acute esophagitis with fibrosis and abundant infiltration of inflammatory cells [9], we considered that blockade of initial inflammation is important for prevention of the strictures. The side effects of steroid encountered in the course of therapy were only moon face that resolved with withdrawal of steroids, and any serious side effects such as immunosuppression, osteoporosis, adrenal insufficiency, diabetes, gastrointestinal ulcers were not experienced, suggesting that a short course of high-dose steroids does not pose a major systemic risk to the patients.…”

Section: Discussionmentioning

confidence: 99%

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High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone

et al. 2008

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One of the most serious problems in patients with long-gap esophageal atresia or corrosive esophagitis is esophageal stricture, which may require esophageal resection and replacement. We describe two cases with persistent esophageal stricture successfully managed by high dose intravenous methylprednisolone following balloon dilatation. High-dose methylprednisolone with gradual tapering (daily 25, 15, 10, 5, 2 mg/kg for 4 days each) plus cimetidine and ampicillin for 1 week was intravenously administrated immediately after balloon dilatation of the esophageal stenosis. This was followed by oral prednisolone (daily 2, 1, 0.5 mg/kg for 1 week each) for persistent esophageal stricture. High dose intravenous methylprednisolone therapy was given to two patients. One patient was a 5-year-old boy with long-gap esophageal atresia who had undergone repair of the esophagus resulting in severe anastomotic stenosis of 3 cm in length. The other case was a 10-year-old boy with corrosive stenosis caused by alkali ingestion. Both patients had been requiring balloon dilatation of the esophagus with intralesional injection of dexamethasone every 3 weeks for more than 1 year to tolerate oral feeding. After the high-dose methylprednisolone protocol was initiated, the symptoms of dysphagia or choking dramatically improved in both patients, and they remained symptom-free for 8 and 7 months. There were complications of moon faces that resolved concomitantly with the withdrawal of oral prednisolone in both cases. High dose intravenous methylprednisolone in addition to intralesional injection of dexamethasone following balloon dilation is an effective therapeutic strategy for persistent esophageal strictures.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone

et al. 2008

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“…Moreover, postoperative stenosis frequently recurs and demands many dilation sessions, turning into refractory strictures [5,7,8].…”

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confidence: 99%

A prospective randomized trial of intralesional triamcinolone injections after endoscopic dilation for complex esophagogastric anastomotic strictures

et al. 2014

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“…2 Management by dilitation and corticosteroid injections has been described as a safe and effective means for managing postoperative esophagogastric strictures. 3 We present three cases of postoperative anastomotic stricture that were refractory to serial dilations and were successfully managed by intrastricture injection of corticosteroids and dilation.…”

mentioning

confidence: 99%

The Strictured Anastomosis: Successful Treatment by Corticosteroid Injections—Report of Three Cases and Review of the Literature

Lucha

Fticsar

Francis

2005

Diseases of the Colon &Amp; Rectum

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Clinically significant anastomotic strictures usually only occur with very low colorectal anastomoses below the level of the peritoneal reflection. The reported rate averages 8 percent and has been attributed to tissue ischemia, localized sepsis, anastomotic leak, proximal fecal diversion, radiation injury, inflammatory bowel disease, and recurrent rectal cancer. Most patients will have symptoms of obstipation, frequent small bowel movements, and bloating. Symptomatic strictures are often approached by dilation (balloon or Hegar) or less often repeat resection. Many of these patients have anastomoses that are too low to consider repeat resection. Strictureplasty with linear stapling devices, stricture resection by use of the circular stapling device, and repeat dilations have all been described. Steroid injections into the stricture have been described in strictured esophagogastric anastomoses but have not been commonly used for strictured coloproctostomies. We describe three cases of coloanal stricture following resections that were complicated by postoperative pelvic abcesses, anastomatic leaks, and pelvic fibrosis. Two cases had undergone low coloanal anastomosis that was protected by a loop ileostomy and developed as significant stricture in the early postoperative period. The third case was managed without a protective loop ileostomy. These were initially managed by repeated dilation of the anastomosis. Each episode was followed by rapid recurrence of the stricture. All patients underwent subsequent dilation with injection of 40 mg of triamcinolone acetate (divided dose in four quadrants) into the stricture and subsequent complete resolution of the stricture. Those patients with loop ileostomies had them taken down and all have been followed for up to 12 months without clinical or endoscopic evidence of recurrent stricture.

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Endoscopic dexamethasone injection following balloon dilatation of anastomotic stricture after esophagogastrostomy

Cited by 56 publications

References 3 publications

High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone

High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone

A prospective randomized trial of intralesional triamcinolone injections after endoscopic dilation for complex esophagogastric anastomotic strictures

The Strictured Anastomosis: Successful Treatment by Corticosteroid Injections—Report of Three Cases and Review of the Literature

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