LAUSR

Endoscopic esophageal dilation has been the primary therapy in severe corrosive stricture. There is a few study on effectiveness of intralesional steroid injection combined with esophageal dilation. The author studied factors that may give positive or negative effect results of dilation, and may extend the indication of dilation before definite surgery. The authors reviewed the complete medical records as the retrospective study of patients those underwent intralesional steroid injection combined with esophageal dilation due to severe corrosive stricture. Primary outcome is the success rate of treatment by intralesion steroid injection combined with endoscopic esophageal stricture dilation. Secondary outcome is the risk that effect result of treatment. Statistical analysis was performed using STATA version 12 for Fisher's exact, students t-test, and relative risk regression, p-value of < 0.05 isconsidered as statistical significant. There are 55 patients was enrolled and presented with at least grade 4 of dysphagia, Marchand's grade III and IV from imaging stress review, and received intralesional steroid injection combined with endoscopic esophageal dilation. We divided patients into two groups, (1) a success esophageal dilation group (76.36%; mean number of dilation is 6 sessions/year), and (2) a failure esophageal dilation group whounderwent reconstruction surgery (23.64%). Patient characteristics including gender, age, time from transfer to the first dilation, type of corrosive agent, grading of dysphagia, number, length of lesion(s), and site of lesion(s). This study showed that gender, age, type of substance, number or length of stricture(s) had no significant difference about the result of treatment. Significant success factors are timing from first swallowing to first dilation (within 8 weeks, 78.57% success), no gastric deformity combined with esophageal stricture (90.48% success), and failure factor is the occurrence of complication during the period of treatment (69.23%) that mainly related to long segment of stricture more than 5 centimeters. We gained high success rate in Marchand's grade III and IV by steroid injection combined with esophageal dilation. Predictors indicate that specific factor caused failure of treatment. The author extends the indication for endoscopic intervention in severe esophageal stricture before decision to do reconstructive surgery. All authors have declared no conflicts of interest.