The use of Triamcinolone Injection in treatment of refractory benign Esophageal Stricture in children
DOI:
https://doi.org/10.52783/jns.v14.1803Keywords:
Savary-Gilliard dilator, periodic dilatation index, dysphagiaAbstract
Objectives: To evaluate the efficacy of Intra-lesional triamcinolone injection in the management of refractory benign esophageal Stricture in children.
Methods: Before endoscopic dilatation, triamcinolone acetate (40 mg/ml) was be applied in the first 5 dilations with an interval of one week between the first and second dilation and then every 2 weeks.
Results: A total of 67 children with refractory benign esophageal stricture out of 183 children (36.6%) who presented with esophageal stricture were enrolled in the study, Cause of esophageal stricture was post-corrosive injury (n=59, 88.1%), with a smaller proportion attributed to post-TEF repair (n=8, 11.9%), There was a significant reduction in the number of dilatations required before and after the triamcinolone injections. The mean maximum dilation improved from 10.66 mm SG(Savary-Gilliard) before injections to 13.13 mm SG after injections, periodic dilatation index (PDI) showed significant reduction post-treatment. The mean PDI decreased from 1.07 to 0.27, There was a significant improvement in the grades of dysphagia, there was no significant changes in cortisone levels, ACTH (Adrenocorticotropic hormone) levels showed no significant change, there were no major complications of the procedure.
Conclusion: findings suggest that intralesional triamcinolone injection is an effective and safe treatment option for refractory benign esophageal strictures in children.
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Sehgal V, Sami S. Management of chronic refractory oesophageal strictures. Current Treatment Options in Gastroenterology. 2021;19(3):443-58.
Shah JN. Benign refractory esophageal strictures: widening the endoscopist's role. Gastrointestinal endoscopy. 2006;63(1):164-7.
Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive substances ingestion: a review. Crit Rev Toxicol. 2020;49(8):637-69.
Arnold M, Numanoglu A, editors. Caustic ingestion in children—a review. Seminars in pediatric surgery; 2017: Elsevier.
Serhal L, Gottrand F, Sfeir R, Guimber D, Devos P, Bonnevalle M, et al. Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations. Journal of pediatric surgery. 2010;45(7):1459-62.
Vergouwe FW, Vlot J, IJsselstijn H, Spaander MC, van Rosmalen J, Oomen MW, et al. Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study. Archives of disease in childhood. 2019;104(2):152-7.
Tambucci R, Angelino G, De Angelis P, Torroni F, Caldaro T, Balassone V, et al. Anastomotic strictures after esophageal atresia repair: incidence, investigations, and management, including treatment of refractory and recurrent strictures. Frontiers in pediatrics. 2017;5:120.
Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World journal of gastroenterology: WJG. 2013;19(25):3918.
Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointestinal Endoscopy. 2005;62(3):474-5.
Poddar U, Thapa BR. Benign esophageal strictures in infants and children: results of Savary-Gilliard bougie dilation in 107 Indian children. Gastrointestinal endoscopy. 2001;54(4):480-4.
Nijhawan S, Udawat H, Nagar P. Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion. Diseases of the Esophagus. 2016;29(8):1027-31.
Méndez-Nieto C, Zarate-Mondragón F, Ramírez-Mayans J, Flores-Flores M. Topical mitomycin C versus intralesional triamcinolone in the management of esophageal stricture due to caustic ingestion. Revista de Gastroenterología de México (English Edition). 2015;80(4):248-54.
Henskens N, Wauters L, Vanuytsel T. Intralesional steroid injections in addition to endoscopic dilation in benign refractory esophageal strictures: a systematic review. Acta Gastro-Enterologica Belgica. 2020;83(3).
Ogilvie A, Dronfield M, Ferguson R, Atkinson M. Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy. Gut. 1982;23(12):1060-7.
Abdelhay S, Mousa M, Elsherbeny MS. Corticosteroid injection of impassable caustic esophageal strictures without dilatation: Does it pave the way to interval endoscopic dilatation? Journal of Pediatric Surgery. 2020;55(11):2348-51.
Kochhar R, Ray JD, Sriram PV, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointestinal endoscopy. 1999;49(4):509-13.
Ismail N, Mansour SE-S, Hussien HM. The Efficacy Of Intralesional Steroid Injection in The Treatment Of Corrosive Esophageal Strictures in Children. Zagazig University Medical Journal. 2021;27(1):48-57.
Zhang Y-W, Wei F-X, Qi X-P, Liu Z, Xu X-D, Zhang Y-C. Efficacy and safety of endoscopic intralesional triamcinolone injection for benign esophageal strictures. Gastroenterology research and practice. 2018;2018(1):7619298.
Takahashi H, Arimura Y, Okahara S, Kodaira J, Hokari K, Tsukagoshi H, et al. A randomized controlled trial of endoscopic steroid injection for prophylaxis of esophageal stenoses after extensive endoscopic submucosal dissection. BMC gastroenterology. 2015;15:1-10.
Szapáry L, Tinusz B, Farkas N, Márta K, Szakó L, Meczker Á, et al. Intralesional steroid is beneficial in benign refractory esophageal strictures: A meta-analysis. World Journal of Gastroenterology. 2018;24(21):2311.
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. Journal of Gastroenterology and Hepatology. 2004;19(12):1388-91.
Narayanan L, Mohamed K, R A, Pai A, N A. Efficacy of intralesional triamcinolone injection in the management of benign refractory esophageal strictures. International Journal of Research in Medical Sciences. 2022;10:1682.
Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointestinal endoscopy. 2002;56(6):829-34.
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. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2012;22(6):518-22.
Camargo MA, Lopes LR, Andreollo N, Brandalise N. Use of corticosteroids after esophageal dilations on patients with corrosive stenosis: prospective, randomized and double-blind study. Revista da Associacao Medica Brasileira (1992). 2003;49(3):286-92.
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):91-4.
Pereira-Lima JC, Lemos Bonotto M, Hahn GD, Watte G, Lopes CV, dos Santos CEO, et al. A prospective randomized trial of intralesional triamcinolone injections after endoscopic dilation for complex esophagogastric anastomotic strictures: steroid injection after endoscopic dilation. Surgical endoscopy. 2015;29:1156-60.
Ramage Jr JI, 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. Official journal of the American College of Gastroenterology| ACG. 2005;100(11):2419-25.
Helal AA, Daboos MA. Five years’ experience of combined intralesional therapy in infantile hemangioma. Annals of Pediatric Surgery. 2019;15:1-6.
van Hal AR, Pulvirenti R, den Hartog FP, Vlot J. The Safety of Intralesional Steroid Injections in Young Children and Their Effectiveness in Anastomotic Esophageal Strictures—A Meta-Analysis and Systematic Review. Frontiers in Pediatrics. 2022;9:825030.
Divarci E, Celtik U, Dokumcu Z, Ozcan C, Erdener A. The efficacy of intralesional steroid injection in the treatment of corrosive esophageal strictures in children. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2016;26(6):e122-e5.
Gandhi RP, Cooper A, Barlow BA. Successful management of esophageal strictures without resection or replacement. Journal of pediatric surgery. 1989;24(8):745-50.
Ahn Y, Coomarasamy C, Ogra R. Efficacy of intralesional triamcinolone injections for benign refractory oesophageal strictures at Counties Manukau Health, New Zealand. The New Zealand Medical Journal (Online). 2015;128(1416):44.
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. Clinical Gastroenterology and Hepatology. 2013;11(7):795-801. e1.
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