Esophageal strictures: Management beyond dilation

Table 6 Characteristics of the studies that evaluated the effect of intralesional steroid in refractory esophageal strictures

Ref.	Study type and number of patients	Etiology of stricture	Dilator used	Steroid application	Outcome
Ramage et al[23], 2005	Randomised controlled trial, n = 15 (steroid arm)	Peptic: 15	Balloon	20 mg triamcinolone into each quadrant at the narrowest part (pre-dilation) With each dilation	Number of follow-up dilations, time to first repeat dilation was not different among the two groups (P > 0.05)
Ahn et al[27], 2015	Case series, n = 25	Anastomotic: 1, eosinophilic esophagitis: 3, peptic: 17, radiation: 4	Bougie or balloon	10 mg triamcinolone into each quadrant at the proximal margin and into the stricture segment (post-dilation) with each dilation	Mean PDI decreases significantly after steroid injection (0.58 vs 0.28, P < 0.05)
Kochhar et al[28], 1999	Case series, n = 17	Corrosive: 17	Bougie	10-15 mg triamcinolone at the proximal margin and into the stricture (pre-dilation in 13 patients and post-dilation in 4 patients). Injections repeated if no subjective response at subsequently scheduled session (maximum: 3)	Median PDI decreases significantly after steroid injection (1.67 vs 0.32, P < 0.01)
Kochhar et al[29], 2002	Case series, n = 71	Anastomotic: 19, corrosive: 29, peptic: 14, radiation: 9	Bougie	10 mg triamcinolone into each quadrant at the proximal margin and into the strictured segment (pre-dilation in 63 patients and post-dilation in 8 patients). Injections repeated if no subjective response at subsequently scheduled session (maximum: 4)	Mean PDI decreases significantly after steroid injection (1.24 vs 0.51, P < 0.001)
Lee et al[30], 1995	Case series, n = 31	Anastomotic: 8, corrosive: 1, peptic: 12, pill esophagitis: 1, radiation: 6, sclerotherapy: 1	Bougie or balloon	28 mg triamcinolone into each quadrant at the narrowest region of the stricture (post-dilation) with each dilation	The mean number of dilations significantly reduced with steroid injection (P < 0.05)
Nijhawan et al[31], 2016	Case series, n = 11	Caustic: 11	Bougie	10 mg triamcinolone into the proximal margin of the stricture and the strictured segment (if long stricture) (post-dilation), weekly for 5 weeks	Mean PDI decreases significantly after steroid injection (2.54 vs 0.19, P < 0.001)

PDI: Periodic dilation index.