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Endoscopic steroid injection reduced frequency of repeat dilation in patients with anastomotic stenosis after esophagectomy

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Abstract

Background

The incidence of anastomotic stenosis ranges from 26 to 42 % in patients who have undergone esophagectomy. Stenosis reduces patient quality of life and requires multiple endoscopic balloon dilations (EBDs). We investigated the effects of EBD with intralesional steroid injection on anastomotic re-stenosis after EBD.

Methods

We retrospectively analyzed 30 esophageal cancer patients who experienced anastomotic stricture after primary surgical resection. All patients had subtotal esophagectomy and cervical anastomosis with retrosternal reconstruction route. The diagnosis of anastomotic stenosis was based on a dysphagia score of 2 or more. Ten patients were treated with EBD and endoscopic corticosteroid injections (steroid group), and 20 were treated with only endoscopic balloon dilation (control group). In the steroid group, triamcinolone acetonide was evenly injected around the anastomosis. We compared the clinical outcomes.

Results

The number of EBDs, measured from the beginning to the release of stricture, was significantly lower in the steroid group than in the control group [2.5 (1–6) vs. 4.5 (1–20), p = 0.033]. Moreover, the period between the first dilatation and the release from stenosis in the steroid group was significantly shorter than that in the control group [58.5 days (0–142 days) vs 94.5 days (0–518 days), p = 0.047]. Bleeding occurred at the anastomotic site in one case in the steroid group, but was completely controlled by endoscopic hemostasis. No other complications were observed in both groups.

Conclusions

Intralesional steroid injection with EBD for treating anastomotic stenosis after esophagectomy is beneficial for reducing the number of repeat EBDs performed and shortening the period before release from stenosis.

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Abbreviations

EBD:

Endoscopic balloon dilation

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Ethical Statement

Our studies were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and subsequent revisions. Written informed consent was obtained from participants.

Conflict of interest

There are no financial or other relations that could lead to a conflict of interest. There are no non-financial competing interests (political, personal, religious, ideological, academic, intellectual, commercial or any other) to declare in relation to this manuscript.

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Authors and Affiliations

  1. Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan

    Keijiro Sugimura, Masaaki Motoori, Masahiko Yano, Norikatsu Miyoshi, Hirofumi Akita, Kunihito Goto, Shogo Kobayashi, Hidenori Takahashi, Takeshi Omori, Shingo Noura, Masayuki Ohue, Yoshiyuki Fujiwara & Masato Sakon

  2. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan

    Ryu Ishihara & Noboru Hanaoka

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  1. Keijiro Sugimura
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  2. Masaaki Motoori
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Correspondence to Keijiro Sugimura.

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Sugimura, K., Motoori, M., Yano, M. et al. Endoscopic steroid injection reduced frequency of repeat dilation in patients with anastomotic stenosis after esophagectomy. Esophagus 13, 62–67 (2016). https://doi.org/10.1007/s10388-015-0495-3

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  • DOI: https://doi.org/10.1007/s10388-015-0495-3

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