Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2311
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
To analyze the effect of intralesional steroid injections in addition to endoscopic dilation of benign refractory esophageal strictures.
A comprehensive search was performed in three databases from inception to 10 April 2017 to identify trials, comparing the efficacy of endoscopic dilation to dilation combined with intralesional steroid injections. Following the data extraction, meta-analytical calculations were performed on measures of outcome by the random-effects method of DerSimonian and Laird. Heterogeneity of the studies was tested by Cochrane’s Q and I2 statistics. Risk of quality and bias was assessed by the Newcastle Ottawa Scale and JADAD assessment tools.
Eleven articles were identified suitable for analyses, involving 343 patients, 235 cases and 229 controls in total. Four studies used crossover design with 121 subjects enrolled. The periodic dilation index (PDI) was comparable in 4 studies, where the pooled result showed a significant improvement of PDI in the steroid group (MD: -1.12 dilation/month, 95%CI: -1.99 to -0.25 P = 0.012; I2 = 74.4%). The total number of repeat dilations (TNRD) was comparable in 5 studies and showed a non-significant decrease (MD: -1.17, 95%CI: -0.24-0.05, P = 0.057; I2 = 0), while the dysphagia score (DS) was comparable in 5 studies and did not improve (SMD: 0.35, 95%CI: -0.38, 1.08, P = 0.351; I2 = 83.98%) after intralesional steroid injection.
Intralesional steroid injection increases the time between endoscopic dilations of benign refractory esophageal strictures. However, its potential role needs further research.
Core tip: Benign refractory stricture can be a very challenging pathology, which requires regular endoscopic dilations. Results of this meta-analysis suggest that endoscopic intralesional steroid injection significantly decreases the frequency of the endoscopic dilations in benign refractory esophageal strictures. In addition, there are very few and mild complications reported in association with this method. We believe that the benefits of intralesional steroid in the treatment of benign refractory stricture overweigh its risks. However, further research would be essential on this treatment method, as there are no data concerning its efficacy and safety in different etiologies of refractory esophageal strictures.