Intralesional Steroid Injection Therapy for Esophageal Anastomotic Stricture Following Esophageal Atresia Repair

Objectives:The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in patients with esophageal atresia remains unclear. The aim of this study was to evaluate the efficacy and safety of ISI.Methods:A total of 158 patients with esophageal atresia with at least 1 ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with dilation alone (ISI-) and dilation with steroid injection (ISI+).Results:A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the ISI+ group: 1mm (interquartile range [IQR] 0, 3) versus 0mm (IQR -1, 1.5) (P<0.0001). The ISI+ group had greater percentage of improved diameter (P<0.0001) and lesser percentages of unchanged and decreased diameters at subsequent endoscopy (P=0.0009, P=0.003). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter with an adjusted odds ratio of 3.24 (95% confidence interval: 2.15-4.88) (P<0.001). The ΔD for the first 3 ISI+ procedures was greater than the ΔD for subsequent ISI+ procedures: 1mm (IQR 0, 3) versus 0.5mm (IQR-1.25, 2) (P=0.001). There was no difference in perforation incidence between ISI+ and ISI- groups (P=0.82).Conclusions:ISI with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first 3 ISI procedures.