Intralesional steroid is beneficial in benign refractory esophageal strictures: A meta-analysis

Abstract

AIMTo analyze the effect of intralesional steroid injections in addition to endoscopic dilation of benign refractory esophageal strictures.METHODSA comprehensive search was performed in three databases from inception to 10 April 2017 to identify trials, comparing the efficacy of endoscopic dilation to dilation combined with intralesional steroid injections. Following the data extraction, meta-analytical calculations were performed on measures of outcome by the random-effects method of DerSimonian and Laird. Heterogeneity of the studies was tested by Cochrane’s Q and I2 statistics. Risk of quality and bias was assessed by the Newcastle Ottawa Scale and JADAD assessment tools.RESULTSEleven articles were identified suitable for analyses, involving 343 patients, 235 cases and 229 controls in total. Four studies used crossover design with 121 subjects enrolled. The periodic dilation index (PDI) was comparable in 4 studies, where the pooled result showed a significant improvement of PDI in the steroid group (MD: -1.12 dilation/month, 95%CI: -1.99 to -0.25 P = 0.012; I2 = 74.4%). The total number of repeat dilations (TNRD) was comparable in 5 studies and showed a non-significant decrease (MD: -1.17, 95%CI: -0.24-0.05, P = 0.057; I2 = 0), while the dysphagia score (DS) was comparable in 5 studies and did not improve (SMD: 0.35, 95%CI: -0.38, 1.08, P = 0.351; I2 = 83.98%) after intralesional steroid injection.CONCLUSIONIntralesional steroid injection increases the time between endoscopic dilations of benign refractory esophageal strictures. However, its potential role needs further research.

Triple intramural dexamethasone injections increase the efficiency of endoscopic bougienage of esophageal re-stenosis and anastomosis

“…Различный патогенез и связанный с ним потенциально различный эффект лечения затрудняют интерпретацию результатов, поскольку число пациентов в каждой подгруппе часто невелико [14]. Учитывая выраженный противовоспалительный и противоотечный механизм действия глюкокортикоидов, можно предположить, что инъекции стероидных препаратов смогут уменьшить степень плотности рубцовой ткани и улучшить результаты эндоскопического лечения стриктур, склонных к рецидивированию [15,16].…”

Intralesional steroids and endoscopic dilation for anastomotic strictures after esophagectomy: systematic review and meta-analysis

“…The study showed that adding steroid injection to dilation was effective for anastomotic strictures but not for caustic strictures. A meta-analysis by Szapary et al [25] evaluated intralesional steroid injections for all benign refractory esophageal strictures and showed that steroid injections increased the time between dilations. However, dysphagia scores did not show much improvement after steroid injections.…”

Acute Management in Corrosive Ingestion

“…Esophageal dilatation can be performed repeatedly according to schedule and using various dilators such as Maloney-Hurst, Savary-Gilliard, and Balloon dilator under the endoscopy, fluoroscopy, or both. Alternative Acute Management in Corrosive Ingestion DOI: http://dx.doi.org/10.5772/intechopen.101475 methods for post-corrosive esophageal stricture such as esophageal stenting [21,37,38], intralesional steroids [21,[39][40][41][42][43], and, Mitomycin-C [21,[44][45][46][47][48] have been published with various outcomes. These options might supplement dilation with better results.…”