Long-Term Efficacy of Repeated Endoscopic Incision Combined with Triamcinolone Injection in Patients with Recurrent Benign Esophageal Stricture.

Abstract

Background and aims: Endoscopic incision (EI) combined with triamcinolone (TAA) injection has emerged as an effective method for treating benign esophageal stricture (BES). However, a single EI and TAA injection seems to be insufficient for long-term relief of BES in some patients, especially those with recurrent BES. Here, we aimed to investigate the long-term efficacy and safety of repeated EIs and TAA injections in patients with recurrent BES.

Methods: Patients with recurrent BES who previously underwent endoscopic dilation or EI were enrolled in this retrospective study. All patients underwent multiple EIs and TAA injections. Patients were followed for at least 12 months. The primary outcome was the rate of re-stricture at 6 months after repeated EIs and TAA injections. The secondary outcomes included the symptom relief rate, the change in Stooler's dysphagia score (0, normal swallowing; 1, semidry food intake only; 2, soft food intake only; 3, fluid only; and 4, no oral intake) and body mass index (BMI) at 6 months, and overall adverse events (AEs). The risk factors for 6-month re-stricture were identified using logistic regression analysis.

Results: A total of 73 patients were enrolled in this study, including 30 (41.1%) with esophagogastric anastomotic strictures, 15 (20.5%) with caustic injury-related strictures, 14 (19.2%) who developed strictures after ESD, 5 (6.8%) with esophagojejunal anastomotic strictures and 9 (12.3%) with other types of strictures. A total of 264 EIs and TAA injections were performed, with 3 (IQR: 2, 5) treatments for each patient. The 6-month re-stricture rate was 53.4%, and the 2-month, 3-month, and 12-month re-stricture rates were 43.8%, 48.0%, and 54.8%, respectively. The 2-month, 3-month, 6-month, and 12-month dysphagia relief rates were 75.3%, 65.8%, 56.2%, and 54.8%, respectively. At 6 months after treatments, the median Stooler's dysphagia score had decreased from 4 (IQR: 4, 4) to 2 (IQR: 0, 4) (P < 0.001), and the median BMI had increased from 19.6 (IQR: 16.9, 21.8) kg/m² to 20.8 (IQR: 17.4, 22.6) kg/m² (P < 0.001). Bile reflux (OR 9.90, 95% CI: 0.99-98.43) and the number of EIs (OR 1.68, 95% CI: 1.17-2.41) were independently associated with 6-month re-stricture after repeated EIs and TAA injections. Four EI-related perforations were successfully treated with a covered metal stent (n = 3) and rescue surgery (n = 1).

Conclusions: Repeated EIs and TAA injections were effective and reasonably safe in managing recurrent BES. However, the long-term efficacy remains suboptimal, thus further investigations are needed.