title: Endoscopic corticosteroid injections do not reduce dysphagia after endoscopic dilation therapy in patients with benign esophagogastric anastomotic strictures.
abstract: OBJECTIVE
  Benign anastomotic strictures are often difficult to treat. We assessed the efficacy of adding corticosteroid injections to endoscopic dilation therapy with Savary bougienage.
  
  
  METHODS
  In a multicenter, double-blind trial, 60 patients (mean age, 63 ± 9 years; 78% male) with an untreated cervical anastomotic stricture after esophagectomy with gastric tube reconstruction and dysphagia for at least solid food were randomly assigned to groups given 4 quadrant injections of 0.5 mL triamcinolone (40 mg/mL, n = 29) or saline (controls, n = 31) into the stricture, followed by Savary dilation to 16 mm. Dysphagia, complications, and quality of life were assessed after 1 and 2 weeks and 1, 3, and 6 months. The primary end point was a dysphagia-free period of 6 months.
  
  
  RESULTS
  In the corticosteroid group, 45% of the patients remained dysphagia-free for 6 months, compared with 36% of controls (relative risk, 1.26; 95% confidence interval, 0.68-2.36; P = .46). Median time to repeat dilation was 108 days (range, 15-180 days) in the corticosteroid group vs 42 days (range, 17-180 days) for controls (P = .11). A median number of 2 dilations (range, 1-7) was performed in the corticosteroid group vs 3 dilations (range, 1-9) in controls (relative risk, 0.76; 95% confidence interval, 0.42-1.38; P = .36). Two major intervention-related complications occurred, 1 submucosal laceration in the corticosteroid group and 1 hemorrhage in the control group. Four patients in the corticosteroid group, but none of the controls, developed Candida esophagitis (P = .03).
  
  
  CONCLUSIONS
  Corticosteroid injections do not provide a statistically significant decrease in frequency of repeat dilations or prolongation of the dysphagia-free period in patients with benign anastomotic esophagogastric strictures. Dutch Trial Registration Number 2236.
authors: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. m.m.c.hirdes@umcutrecht.nl
authors: Meike M C
authors: MM
authors: Hirdes
authors: Jeanin E
authors: JE
authors: van Hooft
authors: Jan J
authors: JJ
authors: Koornstra
authors: Robin
authors: R
authors: Timmer
authors: Max
authors: M
authors: Leenders
authors: Rinse K
authors: RK
authors: Weersma
authors: Bas L A M
authors: BL
authors: Weusten
authors: Richard
authors: R
authors: van Hillegersberg
authors: Mark I
authors: MI
authors: van Berge Henegouwen
authors: John T M
authors: JT
authors: Plukker
authors: Renee
authors: R
authors: Wiezer
authors: Jaques G H M
authors: JG
authors: Bergman
authors: Frank P
authors: FP
authors: Vleggaar
authors: Paul
authors: P
authors: Fockens
authors: Peter D
authors: PD
authors: Siersema
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003680:Deglutition Disorders / Q000188:drug therapy*; D004311:Double-Blind Method; D004724:Endoscopy / Q000379:methods; D004940:Esophageal Stenosis / Q000150:complications / Q000188:drug therapy*; D004943:Esophagogastric Junction / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010919:Placebos / Q000008:administration & dosage; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D010919:Placebos