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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Intralesional steroid is beneficial in benign refractory esophageal strictures: A meta-analysis
László Szapáry, Benedek Tinusz, Nelli Farkas, Katalin Márta, Lajos Szakó, Ágnes Meczker, Roland Hágendorn, Judit Bajor, Áron Vincze, Zoltán Gyöngyi, Alexandra Mikó, Dezső Csupor, Péter Hegyi, Bálint Erőss
László Szapáry, Benedek Tinusz, Katalin Márta, Lajos Szakó, Ágnes Meczker, Alexandra Mikó, Péter Hegyi, Bálint Erőss, Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Nelli Farkas, Institute of Bioanalysis, Medical School, University of Pécs, Pécs 7624, Hungary
Roland Hágendorn, Judit Bajor, Áron Vincze, Department of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Zoltán Gyöngyi, Department of Public Health Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Dezső Csupor, Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged 6720, Hungary
Author contributions: Szapáry L, Erőss B and Hegyi P designed the research and the study concept; Szapáry L and Tinusz B performed the data extraction; Farkas N analysed and interpreted the data; Szapáry L and Tinusz B performed the quality assessment; Szapáry L, Tinusz B, and Erőss B wrote the article; Hágendorn R, Bajor J, Vincze Á, Gyöngyi Z, Mikó A supervised the study; Márta K, Szakó L, Meczker Á, Csupor D, Hegyi P and Erőss B conducted a critical revision of the manuscript for important intellectual content; all of the co-authors granted final approval of the version of the article to be published.
Supported by the Project Grant (KH125678 to PH) and an Economic Development and Innovation Operative Program Grant (GINOP 2.3.2-15-2016-00048 to PH) from the National Research, Development and Innovation Office.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bálint Erőss, MD, Assistant Professor, Doctor, Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs 7624, Hungary. eross.balint@pte.hu
Telephone: +36-72-536246 Fax: +36-72-536247
Received: March 14, 2018
Peer-review started: March 15, 2018
First decision: March 27, 2018
Revised: March 29, 2018
Accepted: April 23, 2018
Article in press: April 23, 2018
Published online: June 7, 2018
ARTICLE HIGHLIGHTS
Research background
Benign refractory esophageal stricture deteriorates the quality of life, as impaired and often painful swallowing necessitates semi liquid or liquid diet and leads to poor nutrition. Regular endoscopic dilations are a huge burden to the patients, carry risks of complications, require special expertise, and accessories of the endoscopy unit.
Research motivation
Our aim was to investigate if there is any benefit of intralesional steroid injection in addition to endoscopic dilation in the treatment of refractory esophageal strictures.
Research objectives
This is the first comprehensive article in this topic, taking into account all the available evidences and this study quantifies the effect of intralesional steroid injection in addition to endoscopic dilation of benign refractory esophageal stricture.
Research methods
A meta-analysis was performed following the guidelines of the PRISMA P protocol and the review was registered on PROPSPERO. PubMed, Cochrane Library and Embase databases were comprehensively searched for trials eligible for the analysis, describing the outcomes of dilation in comparison to dilation with intralesional steroids. The risks of bias and quality of the individual studies were assessed by using the Newcastle-Ottawa Scale and JADAD Score. The random effect model described by DerSimonian-Laird was used to perform the statistical calculations.
Research results
The statistical analysis involved 343 patients with benign refractory stricture. The results showed that intralesional steroid significantly increased the time between endoscopic dilations, from 1.3-0.3 dilations/month. However, the dysphagia score and the total number of dilation did not improve.
Research conclusions
Intralesional steroid injection increases the time between endoscopic dilations of benign refractory esophageal strictures.
Research perspectives
Further research would be essential to understand the effects of intralesional steroid injection in the treatment of benign refractory esophageal strictures. A multi-center, double blind, randomized controlled trial could give better answers. Detailed data on the outcomes of the treatment in view of the etiology, the time of the diagnosis, the degree of inflammation/fibrosis, the length and location of the stricture should be collected with a long follow up period.
