Clinical Analysis Of Instralesional Corticosteroid Injection Combine Bougie Dilation In Endoscopic Treatment Of Refractory Benign Esophageal Stricture In Children

Background and Objective: Benign esophageal stricture in children is a benignesophageal disease which is caused by several reason, such as chemical corrosive burnand anastomotic stenosis. The common simultaneous phenomenon is dysphagia.Because the stenosis is difficult to dilate and relapse frequently, it is harmful to thegrowth and development in children. Now the common therapies include esophagealdilation, stent implantation and esophageal reconstruction. Because of the poor curativeeffection and the more complications, it does not have effective treatment measures.Recently corticosteroid is used to treat esophageal stricture. It can delay the formationof granulation tissue. Although some research indict that instralesional corticosteroidinjection can reduce the dilation frequency, it is the small sample study andnon-randomized controlled trial to the adults. Because the etiology of benign esophagealstricture in children is special and their repair capacity is stronger than adults, the risk ofrecurrence and refractory rate is higher. What’s more, on account of steroid usedspecificitily in children, the efficacy of corticosteroid injection in treatment of refractorybenign esophageal stricture in children is still uncertain. And there is on report that theoptimum frequency and best dose of corticosteroid injection used in children. Therefore,this research aims at refractory benign esophageal stricture in children under five yearsold, using the method of self control and randomized control, in order to investigate theefficacy of instralesional corticosteroid injection combine bougie dilation in endoscopic treatment of refractory benign esophageal stricture in children.Methods: Study collected the data of38refractory benign esophageal stricturecases of children which were treated in general hospital of Beijing military regionfrom December2010to June2013. The endoscopy and barium meal examination wereperformed to clear the etiology、position、range and degree of stenosis. The patientswere randomized into control and study groups. The26patients in control groupunderwent only Savary-Gilliard’s bougie dilation therapy, while12patients in the studygroup received an additional instralesional steroid injection after dilation. The injecteddose of steroid was calculated by weight. The children accepted injection for one tothree course (once a week and four times in the first course, once two weeks and twotimes in the second course, once every four weeks and two times in the third course).The number of dilations, the follow-up period, the time of symptomatic relief, thedysphagia score and complications were observed in all children. The recurrence ratewithin three months and the periodic dilation index, which calculated as number ofdilations/the follow-up period, were to determine whether instralesional steroid injectionhad additional benefit to dilation therapy.Results: There was no difference between the control group and the study group insex、age、etiology、location、range and degree of stenosis, neither in dysphagia scorenor the achievement of dilation(P>0.05). The children in two groups carried outsuccessful dilation. The total number of dilation was111(average9.25±2.14) in thestudy group and345(average13.27±6.77) in the control group(t=1.999,P=0.007). Themean periodic dilation index was1.22±0.30in the study group and1.62±0.68in thecontrol group(t=1.909,P=0.007). In the study group, the children accepted68times ofsteroid injection therapy(average5.50±1.51). The mean number of dilation was11.17±5.78and3.75±1.66before and after injections(t=3.712,P=0.035). Additionally,the mean periodic dilation index was2.18±0.59and0.52±0.17before and afterinjections(t=8.132,P=0.025). The mean symptom free interval was92.67±18.49days inthe study group and17.42±11.12days in the control group(t=15.633,P=0.042). Thenumber of dysphagia grades decreased was3.17±0.72in the study group and1.81±0.40 in the control group(t=7.500,P=0.030). In the research, there were six cases occurredreflux esophagitis, one child occurred mild bleeding, one child occurred pulmonaryinfection, one child occurred pneumoderm. The complications aboved wereimprovement with conservative medical management. There was no adverse reactionoccurred with using corticosteroid. There were21children relapse in the followingthree months. The recurrence rate was16.7%in the study group and73.1%in thecontrol group(x2=10.290,P=0.001).Conclusions: Instralesional corticosteroid injection combine bougie dilationdecreased the number and requirement for repetition of dilation, increased the symptomfree interval, and it presented a higher improvement of dysphagia and a lower recentrecurrence rate in children with refractory benign esophageal stricture. It is likely thatinstralesional corticosteroid injection may also be a useful adjunct to bougie dilation inclinical application.