DOZ047.68: Intralesional steroid injection therapy for the treatment of esophageal anastomotic stricture in a pediatric esophageal atresia population

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
P D Ngo ◽  
A Kamran ◽  
S J Clark ◽  
R W Jennings ◽  
T E Hamilton ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Esophageal Atresia ◽  
Steroid Injection ◽  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Injection Therapy ◽  
Efficacy And Safety ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection

Abstract Background and Aims The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in esophageal atresia (EA) patients remains unclear. The aim of this study is to evaluate the efficacy and safety of ISI in a large pediatric EA population. Methods One-hundred fifty eight EA patients who had undergone at least one ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with balloon dilation alone (ISI-) and balloon dilation with steroid injection (ISI+). Assessment for change in efficacy with increasing numbers of ISI interventions was performed. Results A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the group of steroid injection procedures: 1 mm (IQR 0, 3) versus 0 mm (IQR -1, 1.5) (P < 0.0001). The ISI+ group had greater percentage of improved stricture diameter (P < 0.0001) and lesser percentages of unchanged and decreased stricture diameters at subsequent endoscopy (P = 0.0009, P = 0.003). The ΔD for each of an anastomosis’ first 3 ISI+ procedures was greater than the ΔD for its subsequent ISI+ procedures: 1 mm (IQR 0, 3) versus 0.5 mm (IQR -1.25, 2) (P = 0.001). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter. Conclusions This study demonstrates that intralesional steroid injection with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first three ISI procedures.

Intralesional Steroid Injection Therapy for Esophageal Anastomotic Stricture Following Esophageal Atresia Repair

2020 ◽  
Vol 70 (4) ◽  
pp. 462-467 ◽  
Author(s):  
Peter D. Ngo ◽  
Ali Kamran ◽  
Susannah J. Clark ◽  
Russell W. Jennings ◽  
Thomas E. Hamilton ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Steroid Injection ◽  
Anastomotic Stricture ◽  
Injection Therapy ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection

Preliminary experience with endoscopic intralesional steroid injection therapy for refractory upper gastrointestinal strictures

1995 ◽  
Vol 41 (6) ◽  
pp. 598-601 ◽  
Author(s):  
Makau Lee ◽  
Craig M. Kubik ◽  
Clinton D. Polhamus ◽  
Charles E. Brady ◽  
Shailesh C. Kadakia
Keyword(s):  
Steroid Injection ◽  
Injection Therapy ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection ◽  
Upper Gastrointestinal

scholarly journals Intralesional steroid injections to prevent refractory strictures in patients with oesophageal atresia: study protocol for an international, multicentre randomised controlled trial (STEPS-EA trial)

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033030
Author(s):  
Chantal A ten Kate ◽  
John Vlot ◽  
Hanneke IJsselstijn ◽  
Karel Allegaert ◽  
Manon C W Spaander ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Steroid Injection ◽  
Oesophageal Atresia ◽  
Anastomotic Stricture ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Stricture Formation ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection ◽  
Randomised Controlled

IntroductionAnastomotic stricture formation is the most common postoperative complication after oesophageal atresia (OA) repair. The standard of care is endoscopic dilatation. A possible adjuvant treatment is intralesional steroid injection, which is thought to inhibit scar tissue formation and thereby to prevent stricture recurrence. We hypothesise that this intervention could prevent refractory strictures and reduce the total number of dilatations needed in these children.Methods and analysisThis is an international multicentre randomised controlled trial. Children with OA type C (n=110) will be randomised into intralesional steroid injection followed by balloon dilatation or dilatation only. Randomisation and intervention will take place when a third dilatation is performed. The indication for dilatation will be confirmed with an oesophagram. One radiologist—blinded for randomisation—will review all oesophagrams. The primary outcome parameter is the total number of dilatations needed with <28 days’ interval, which will be analysed with a linear-by-linear χ2 association test. Secondary outcome parameters include the level of dysphagia, the luminal oesophageal diameter and stricture length (measured on the oesophagrams), the influence of comedication on stricture formation, systemic effects of intralesional steroids (cortisol levels, length and weight) and the cost-effectiveness. Patients will undergo a second oesophagram; length and weight will be measured repeatedly; a scalp hair sample will be collected; and three questionnaires will be administered. The follow-up period will be 6 months, with evaluation at 2–3 weeks, 3 and 6 months after the intervention.Ethics and disseminationPatients will be included after written parental informed consent. The risks and burden associated with this trial are minimal. The institutional review board of the Erasmus Medical Centre approved this protocol (MEC-2018–1586/NL65364.078.18). The results of the trial will be published in a peer-reviewed scientific journal and will be presented at international conferences.Trial registration numbers2018-002863-24 and NTR7726/NL7484.

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