Endoscopic steroid injection reduced frequency of repeat dilation in patients with anastomotic stenosis after esophagectomy

The incidence of anastomotic stenosis ranges from 26 to 42 % in patients who have undergone esophagectomy. Stenosis reduces patient quality of life and requires multiple endoscopic balloon dilations (EBDs). We investigated the effects of EBD with intralesional steroid injection on anastomotic re-stenosis after EBD. We retrospectively analyzed 30 esophageal cancer patients who experienced anastomotic stricture after primary surgical resection. All patients had subtotal esophagectomy and cervical anastomosis with retrosternal reconstruction route. The diagnosis of anastomotic stenosis was based on a dysphagia score of 2 or more. Ten patients were treated with EBD and endoscopic corticosteroid injections (steroid group), and 20 were treated with only endoscopic balloon dilation (control group). In the steroid group, triamcinolone acetonide was evenly injected around the anastomosis. We compared the clinical outcomes. The number of EBDs, measured from the beginning to the release of stricture, was significantly lower in the steroid group than in the control group [2.5 (1-6) vs. 4.5 (1-20), p = 0.033]. Moreover, the period between the first dilatation and the release from stenosis in the steroid group was significantly shorter than that in the control group [58.5 days (0-142 days) vs 94.5 days (0-518 days), p = 0.047]. Bleeding occurred at the anastomotic site in one case in the steroid group, but was completely controlled by endoscopic hemostasis. No other complications were observed in both groups. Intralesional steroid injection with EBD for treating anastomotic stenosis after esophagectomy is beneficial for reducing the number of repeat EBDs performed and shortening the period before release from stenosis.