BENİGN ÖZOFAGEAL STRİKTÜRLERDE BUJİ DİLATASYONU: ADJUVAN METİLPREDNİZOLON İNJEKSİYONUNUN DEĞERLENDİRİLMESİ

Year 2022, Volume: 85 Issue: 3, 305 - 311, 06.07.2022

İbrahim Hakkı Köker Hakan Şentürk

https://doi.org/10.26650/IUITFD.1011641

Abstract

Amaç: Benign özofageal striktürklerde mekanik dilatasyon sonrası adjuvan triamsinolon asetat (TA) injeksiyonu bujilerle sağlanan açıklığın korunmasında ve buji dilatasyon (BD) seans sayısını azaltmada etkilidirler. Bu çalışmada, buji dilatasyonu sonrasında Metilprednizolon (MP) injeksiyonunun kalıcı/uzun dönem lümen açıklığını sağlamadaki etkinliğini araştırmayı planladık.
Gereç ve Yöntem: Ocak 2017-Ekim 2020 tarihleri arasında benign özofageal darlık (BES) tanısı alan 22 hasta arasından BD ve MP injeksiyon seanslarına alınan ve endoskopik takip programına devam eden 8 hastanın sonuçlarını değerlendirerek literatürle karşılaştırdık.
Bulgular: Farklı etyolojik nedenlere (3 anastomotik, 2 iatrojenik özofageal rüptür onarımı, 2 rekürren web ve 1 skleroderma) bağlı striktürleri olan 8 hastayı [6 (75%) kadın, yaş ortalaması 61±16,9 yıl, (22-77)] buji dilatasyonu ve takiben intralezyonel MP injeksiyonu ile tedavi ettik. Kalıcı açıklığın sağlanması için median BD seans sayısını 3,5 (1-8) saptadık. İntralezyonel olarak uyguladığı- mız median MP injeksiyonu sayısı 3 (1-7) oldu. Striktürlerin medi- an düzelme zamanı 2,5 aydı (1-4). Hastaların median endoskopik takip sürelerini ise 4,5 ay (1-17) olarak belirledik.
Sonuçlar: Mekanik dilatasyon sonrasında sağlanan lümen açıklığının korunmasında adjuvan MP injeksiyonu başarılıdır. Benign özofageal striktürlerde en az dilatasyon sayısı ile optimal kalıcı lümen açlıklığını sağlamada kullanılacak steroid tipi ve dozunu belirlemede randomize kontrollü çalışmalara ihtiyaç vardır.

Keywords

Benign özofageal striktür, buji dilatasyonu, endoskopik tedavi, metilprednizolon

Supporting Institution

Yok

Project Number

Yok

BOUGIE DILATATION IN BENIGN ESOPHAGEAL STRICTURES: EVALUATION OF ADJUVANT METHYLPREDNISOLONE INJECTION

Abstract

Objective: Mechanical dilatation and adjuvant injection of triamcinolone acetate (TA) effectively preserve the opening provided and reduce the number of bougie dilation (BD) in benign esophageal strictures. In this study, we aimed to evaluate the role of Methylprednisolone (MP) injection after BD in providing permanent/long-term lumen opening.
Materials and Methods: Among 22 patients diagnosed with benign esophageal strictures (BES) between January 2017 and October 2020, we evaluated the results of 8 patients who continued the endoscopic follow-up program and underwent BD and MP injection, then compared with the literature.
Results: We treated 8 patients [6 (75%) women, mean age 61±16.9 years (range 22-77)] with strictures of different etiologies (3 anastomotic, 2 iatrogenic esophageal rupture repairs, 2 recurrent webs, and 1 scleroderma) with BD followed by intralesional MP injection. We performed median BD sessions 3.5 times (range 1-8). We gave a median 3 intralesional MP injection (range 1-7). The median time to resolve stricture was 2.5 months (range 1-4). The median endoscopic follow-up time was 4.5 months (range 1-17).
Conclusions: Adjuvant MP injection is successful in preserving the lumen patency provided after mechanical dilatation. Randomized controlled studies are needed to determine the steroid type and dose to provide the most optimal permanent lumen opening with lesser dilatation sessions in BES.

Keywords

Benign esophageal stricture, bougie dilation, endoscopic therapy, Methylprednisolone

Project Number

Yok

References

• 1. Everett SM. Endoscopic management of refractory benign oesophageal strictures. Ther Adv Gastrointest Endosc 2019;12:2631774519862134. [CrossRef] google scholar
• 2. Ashcraft KW, Holder TM. The experimental treatment of esophageal strictures by intralesional steroid injections. J Thorac Cardiovasc Surg 1969;58(5):685-91. [CrossRef] google scholar
• 3. Kiil J. Keloids treated with topical injections of triamcinolone acetonide (Kenalog). Immediate and long-term results. Scand J Plast Reconstr Surg 1977;11(2):169-72. [CrossRef] google scholar
• 4. Zein NN, Greseth JM, Perrault J. Endoscopic intralesional steroid injections in the management of refractory esophageal strictures. Gastrointest Endosc 1995;41(6):596-8. [CrossRef] google scholar
• 5. Lee M, Kubik CM, Polhamus CD, Bradly CE, Kadakia SC. Preliminary experience with endoscopic intralesional steroid injection therapy for refractory upper gastrointestinal strictures. Gastrointest Endosc 1995;41(6):598-601. [CrossRef] google scholar
• 6. Kochhar R, Ray JD, Sriram PVJ, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointest Endosc 1999;49(4 Pt 1):509-13. [CrossRef] google scholar
• 7. Altıntaş E, Kacar S, Tunç B, Sezgin O, Parlak E, Altıparmak E, et al. Intralesional steroid injection in benign esophageal strictures resistant to bougie dilation. J Gastroenterol Hepatol 2004;19(12):1388-91. [CrossRef] google scholar
• 8. Ramage 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. Am J Gastroenterol 2005;100(11):2419-25. [CrossRef] google scholar
• 9. Miyashita M, Onda M, Okawa K, Matsutani T, Yoshiyuki T, Sasajima K, et al. Endoscopic dexamethasone injection following balloon dilatation of anastomotic stricture after esophagogastrostomy. Am J Surg 1997;174(4):442-4. [CrossRef] google scholar
• 10. Manfredi MA. Endoscopic Management of Anastomotic Esophageal Strictures Secondary to Esophageal Atresia. Gastrointest Endosc Clin N Am 2016;26(1):201-19. [CrossRef] google scholar
• 11. Hirdes MM, van Hooft JE, Koornstre 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. Clin Gastroenterol Hepatol 2013;11(7):795-801. [CrossRef] google scholar
• 12. Hanaoka N, Ishihara R, Motoori M, Takeuchi Y, Uedo N, Matsuura N, et al. Endoscopic Balloon Dilation Followed By Intralesional Steroid Injection for Anastomotic Strictures After Esophagectomy: A Randomized Controlled Trial. Am J Gastroenterol 2018;113(10):1468-74. [CrossRef] google scholar
• 13. Pereira-Lima JC, Bonotto ML, 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. Surg Endosc 2015;29(5):1156-60. [CrossRef] google scholar
• 14. Qui Y, Shi R. Roles of steroids in preventing Esophageal Stricture after endoscopic resection. Can J Gastroenterol Hepatol 2019;2019:5380815. [CrossRef] google scholar
• 15. Kadota T, Yoda Y, Hori K, Shinmura K, Oono Y, Ikematsu H, et al. Prophylactic steroid administration against strictures is not enough for mucosal defects involving the entire circumference of the esophageal lumen after esophageal endoscopic submucosal dissection (ESD). Esophagus 2020;17(4):440-7. [CrossRef] google scholar
• 16. Morikawa N, Honna T, Kuroda T, Watanabe K, Tanaka H, Takayasu H, et al. High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone. Pediatr Surg Int 2008;24(10):1161-4. [CrossRef] google scholar
• 17. Henkens N, Wauters L, Vanuytsel T. Intralesional steroid injections in addition to endoscopic dilation in benign refractory esophageal strictures: a systemic review. Acta Gastroenterol Belg 2020;83(3):432-40. google scholar
• 18. Ogilvie AL, Dronfield MW, Ferguson R, Atkinson M. Palliative intubation of oesophagogastric neoplasms at fiberoptic endoscopy. Gut 1982;23(12):1060-7. [CrossRef] google scholar
• 19. Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointest Endsosc 2002;56(6):829-34. [CrossRef] google scholar
• 20. Nijhawan S, Udawat HP, Nagar P. Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion. Dis Esophagus 2016;29(8):1027-31. [CrossRef] google scholar
• 21. 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. Surg Laparosc Endosc Percutan Tech 2012;22(6):518-22. [CrossRef] google scholar