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Up to one third of corrosive ingestion patients will develop esophageal stricture after initial recovery.The primary treatment of esophageal strictures secondary to caustic ingestion is frequent dilation. Refractory cases may respond to intralesional streroids. We aimed to study the effect of intralesional triamcinolone injection in patients who present to our hospital with esophageal strictures post acid ingestion. Methodology: After obtaining approval of the ethics committee, a prospective study was conducted in the Department of Gastroenterology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat from Sept 2015 to Aug 2016. We included all patients who presented to the Emergency Ward with the history of acid ingestion and were refractory to conventional endoscopic balloon dilation with Savary-Gilliard balloon dilator. Triamcinolone acetonide (40mg/mL, diluted 1:1 with saline solution) was injected in four quadrants using a 23 gauge, 5mm long sclerotherapy needle in aliquots of 0.5mL at the proximal margin of the stricture and into the strictured segment. Number of dilations needed before and after steroid injection and dysphagia score was noted for each patient. Results: For 64 patients, mean age of the patients were 22.74 years and 42 were males. Mean number of dilations needed before streroid injection were significantly more than after steroid injection (p<0.0001). Similarly, proportion of patients who could achieve atleast 15 mm dilation was significantly higher after steroid injection as compared to before streroid injection (p<0.0001). Mean dysphagia score also improved signifiantly from 2.64 to 0.81 before and after steroid injection respectively (p<0.0001). Conclusions:Findings of our study support the use of intralesional triamcinolone injections for patients who are refractory to repeated dilations for esophageal stricture after acid ingestion.

Effect of Intralesional Triamcinolone Injection in Patients of Esophageal Stricture Post Acid Ingestion