| Endoscopic Corticosteroid Injections Do Not Reduce Dysphagia Following Endoscopic Dilation Therapy in Patients with Benign Esophagogastric Anastomotic Strictures. | |
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MedLine Citation:
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PMID: 23376318 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: JOURNAL ARTICLE Date: 2013-1-30 |
Journal Detail:
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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:
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Created Date: 2013-2-4 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101160775 Medline TA: Clin Gastroenterol Hepatol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Dept. of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht. Electronic address: M.M.C.Hirdes@umcutrecht.nl. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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