The effect of intralesional steroid injections on esophageal strictures and the child as whole
A case series
Background: The most frequent complication after esophageal atresia repair remains anastomotic stricture formation. The initial treatment is endoscopic dilatation. Intralesional steroid injection (ISI) might be an effective adjuvant treatment in case of recurrent strictures. In this series we present our initial experience with this intervention.
Methods: Data on primary surgery, stricture treatment, postoperative complications, outcome and growth were retrospectively collected from electronic patient records. Findings were analyzed by descriptive statistics and mixed model analysis.
Results: Between 2014 and 2017, ISI was performed for severe recurrent anastomotic strictures in six patients (median age at injection 12.4 (2.1–34.7) months) after a median of 6 (2–20) dilatations. In five patients ISI was successful and the stenosis was cleared. No postoperative complications were reported, especially none related to acute adrenal suppression. Comparing the year before with the year after ISI, a significant positive change for weight (r = 0.70, p = 0.003) was calculated versus a negative change for height (r = − 0.87, p = 0.003).
Conclusions: We found ISI to be an effective adjuvant treatment to recurrent anastomotic stricture dilatation after esophageal atresia repair, without postoperative complications or symptoms of adrenal suppression. It remains important, however, to monitor growth effects. Further evaluation is required in a large prospective study. Type of study: Treatment study, Level IV (case series).
|Keywords||Esophageal atresia, Anastomotic stricture, Intralesional steroid injection, Triamcinolone acetide|
|Persistent URL||dx.doi.org/10.1016/j.jpedsurg.2019.05.013, hdl.handle.net/1765/116753|
|Journal||Journal of Pediatric Surgery|
Ten Kate, C.A, Vlot, J, Sloots, C.E.J, van den Akker, E.L.T, & Wijnen, R.M.H. (2019). The effect of intralesional steroid injections on esophageal strictures and the child as whole. Journal of Pediatric Surgery. doi:10.1016/j.jpedsurg.2019.05.013