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
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.
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.
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.
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.
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.
Intralesional steroid injection increases the time between endoscopic dilations of benign refractory esophageal strictures.
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.