Effectiveness of an orally administered steroid gel at preventing restenosis after endoscopic balloon dilation of benign esophageal stricture

Abstract

Background: Restenosis occurs in 10% to 30% of patients after endoscopic balloon dilation (EBD) of benign esophageal stricture. This study aimed to investigate whether an orally administered steroid/gel mixture would inhibit restenosis after EBD for benign esophageal stricture.

Methods: This retrospective analysis included patients with benign esophageal stricture treated with EBD at the Peking University Third Hospital, China (September 2005 to October 2017). The patients were divided into an EBD alone group (EBD only) and EBD/OHA group (EBD plus oral hydrocortisone sodium succinate/aluminum phosphate gel mixture). Patients were followed-up for 3 months. EBD was repeated for persistent dysphagia. The outcome measures included the restenosis rate and the number of additional EBD sessions required during follow-up. Any side effects were noted.

Results: Thirty-two patients were included (EBD alone group, n = 12; EBD/OHA group, n = 20). Baseline demographic and clinical characteristics (including age, sex, etiology, stricture location, and diameter of narrowest segment) did not differ between groups. Restenosis rate was significantly lower in the EBD/OHA group than in the EBD alone group (5/20, 25.0% vs 8/12, 66.7%; P = .025). The median number of EBD sessions required was numerically lower in the EBD/OHA group (median, 1.0; interquartile range, 1.0-1.8) than in the EBD alone group (median 2.0, interquartile ranged 1.0-2.5), but statistical significance was not attained (P = .071). The only side effects occurred in the EBD/OHA group: hypokalemia in 4/20 (20.0%) and apathy/somnolence in 1/20 (5.0%).

Conclusions: An orally administered steroid/gel mixture might reduce the incidence of restenosis after EBD for benign esophageal stricture, but it requires confirmation by prospective trials.

Figure 1

Representative images obtained during EBD of a benign esophageal stricture. After EBD, this 75-year-old female was treated for 8 weeks with a steroid/gel mixture (administered orally); thus, this patient was allocated to the EBD/OHA group. (A) Esophagography of the esophagus showing stenosis in the upper esophagus. (B) Endoscopic view of the stricture before balloon dilation. (C) Endoscopic view during the process of balloon dilation of the esophagus. (D) Endoscopic view after balloon dilation showing an unobstructed esophagus. EBD = endoscopic balloon dilation, OHA = oral administration of hydrocortisone sodium succinate and aluminum phosphate gel.

Figure 2

Representative images obtained during and after EBD)of a benign esophageal stricture. This 59-year-old male was not treated with the steroid/gel mixture and so was allocated to the EBD alone group. (A) Esophagography of the esophagus showing stenosis in the lower esophagus. (B and C) Endoscopic views obtained during the process of balloon dilation of the esophagus. (D) Endoscopic view after balloon dilation showing an unobstructed esophagus. (E) Esophagography after EBD demonstrated restenosis of the esophagus at 44 days after the original EBD. (F) Endoscopic view showing restenosis of the esophagus at 44 days after the original EBD. EBD = endoscopic balloon dilation.