title: High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone.
abstract: 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.
authors.affiliation: Division of General Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan. morikawa-n@ncchd.go.jp
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Morikawa
authors.forename: Toshiro
authors.initials: T
authors.lastname: Honna
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kuroda
authors.forename: Koji
authors.initials: K
authors.lastname: Watanabe
authors.forename: Hideaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hajime
authors.initials: H
authors.lastname: Takayasu
authors.forename: Akihiro
authors.initials: A
authors.lastname: Fujino
authors.forename: Hiroko
authors.initials: H
authors.lastname: Tanemura
authors.forename: Makoto
authors.initials: M
authors.lastname: Matsukubo
mesh_terms: D000402:Airway Obstruction / Q000188:drug therapy / Q000209:etiology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002404:Catheterization / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000188:drug therapy / Q000209:etiology; D003907:Dexamethasone / Q000008:administration & dosage*; D004940:Esophageal Stenosis / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D015552:Injections, Intralesional; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D008775:Methylprednisolone