Document Detail


Endoscopic Corticosteroid Injections Do Not Reduce Dysphagia Following Endoscopic Dilation Therapy in Patients with Benign Esophagogastric Anastomotic Strictures.
MedLine Citation:
PMID:  23376318     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND & AIMS: 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 y, 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 either 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 endpoint 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 [RR], 1.26; 95% confidence interval [CI], 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 (RR, 0.76; 95% CI, 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:
Meike M C Hirdes; Jeanin E van Hooft; Jan J Koornstra; Robin Timmer; Max Leenders; Rinse K Weersma; Bas L A M Weusten; Richard van Hilligersberg; Mark I van Berge Henegouwen; John T M Plukker; Renee Wiezer; Jaques G H M Bergman; Frank P Vleggaar; Paul Fockens; Peter D Siersema
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-30
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  -     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-2-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Dept. of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht. Electronic address: M.M.C.Hirdes@umcutrecht.nl.
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