Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2018; 24(21): 2311-2319
Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2311
Intralesional steroid is beneficial in benign refractory esophageal strictures: A meta-analysis
László Szapáry, Benedek Tinusz, Nelli Farkas, Katalin Márta, Lajos Szakó, Ágnes Meczker, Roland Hágendorn, Judit Bajor, Áron Vincze, Zoltán Gyöngyi, Alexandra Mikó, Dezső Csupor, Péter Hegyi, Bálint Erőss
László Szapáry, Benedek Tinusz, Katalin Márta, Lajos Szakó, Ágnes Meczker, Alexandra Mikó, Péter Hegyi, Bálint Erőss, Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Nelli Farkas, Institute of Bioanalysis, Medical School, University of Pécs, Pécs 7624, Hungary
Roland Hágendorn, Judit Bajor, Áron Vincze, Department of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Zoltán Gyöngyi, Department of Public Health Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Dezső Csupor, Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged 6720, Hungary
Author contributions: Szapáry L, Erőss B and Hegyi P designed the research and the study concept; Szapáry L and Tinusz B performed the data extraction; Farkas N analysed and interpreted the data; Szapáry L and Tinusz B performed the quality assessment; Szapáry L, Tinusz B, and Erőss B wrote the article; Hágendorn R, Bajor J, Vincze Á, Gyöngyi Z, Mikó A supervised the study; Márta K, Szakó L, Meczker Á, Csupor D, Hegyi P and Erőss B conducted a critical revision of the manuscript for important intellectual content; all of the co-authors granted final approval of the version of the article to be published.
Supported by the Project Grant (KH125678 to PH) and an Economic Development and Innovation Operative Program Grant (GINOP 2.3.2-15-2016-00048 to PH) from the National Research, Development and Innovation Office.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bálint Erőss, MD, Assistant Professor, Doctor, Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs 7624, Hungary. eross.balint@pte.hu
Telephone: +36-72-536246 Fax: +36-72-536247
Received: March 14, 2018
Peer-review started: March 15, 2018
First decision: March 27, 2018
Revised: March 29, 2018
Accepted: April 23, 2018
Article in press: April 23, 2018
Published online: June 7, 2018
Processing time: 81 Days and 12.2 Hours
Abstract
AIM

To analyze the effect of intralesional steroid injections in addition to endoscopic dilation of benign refractory esophageal strictures.

METHODS

A comprehensive search was performed in three databases from inception to 10 April 2017 to identify trials, comparing the efficacy of endoscopic dilation to dilation combined with intralesional steroid injections. Following the data extraction, meta-analytical calculations were performed on measures of outcome by the random-effects method of DerSimonian and Laird. Heterogeneity of the studies was tested by Cochrane’s Q and I2 statistics. Risk of quality and bias was assessed by the Newcastle Ottawa Scale and JADAD assessment tools.

RESULTS

Eleven articles were identified suitable for analyses, involving 343 patients, 235 cases and 229 controls in total. Four studies used crossover design with 121 subjects enrolled. The periodic dilation index (PDI) was comparable in 4 studies, where the pooled result showed a significant improvement of PDI in the steroid group (MD: -1.12 dilation/month, 95%CI: -1.99 to -0.25 P = 0.012; I2 = 74.4%). The total number of repeat dilations (TNRD) was comparable in 5 studies and showed a non-significant decrease (MD: -1.17, 95%CI: -0.24-0.05, P = 0.057; I2 = 0), while the dysphagia score (DS) was comparable in 5 studies and did not improve (SMD: 0.35, 95%CI: -0.38, 1.08, P = 0.351; I2 = 83.98%) after intralesional steroid injection.

CONCLUSION

Intralesional steroid injection increases the time between endoscopic dilations of benign refractory esophageal strictures. However, its potential role needs further research.

Keywords: Intralesional steroid; Meta-analysis; Benign refractory esophageal stricture; Dilation

Core tip: Benign refractory stricture can be a very challenging pathology, which requires regular endoscopic dilations. Results of this meta-analysis suggest that endoscopic intralesional steroid injection significantly decreases the frequency of the endoscopic dilations in benign refractory esophageal strictures. In addition, there are very few and mild complications reported in association with this method. We believe that the benefits of intralesional steroid in the treatment of benign refractory stricture overweigh its risks. However, further research would be essential on this treatment method, as there are no data concerning its efficacy and safety in different etiologies of refractory esophageal strictures.