The major sequelae after corrosive injuries to the upper GI tract are the development of esophageal stricture and gastric cicatrization. We have shown that 38% 1 to 45% 2 of patients who ingest strong acid or alkali develop esophageal strictures. Tradi- tionally, treatment of such patients has been period- ic endoscopic dilation or surgery. As compared with peptic strictures, corrosive strictures are difficult to dilate. They require more dilation sessions and the chance of recurrence is also higher. 3 The factors responsible for recurrence are not clear but could be intense fibrogenesis that occurs during healing and further fibrosis subsequent to the trauma of dila- tions. Based on successful use in dermatologic scars such as keloids and burns scars, 4,5 intralesional injection of corticosteroids has been used effectively in refractory esophageal strictures of various etiolo- Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures Rakesh Kochhar, MD, DM, Jay Deb Ray, MD, DM, Parupudi V. J. Sriram, MD, DM, Sanjay Kumar, MD, DM, Kartar Singh, MD, DM Chandigarh, India Background: Intralesional corticosteroid injection has been shown to be effective in refractory esophageal strictures of various etiologies. The present study was con- ducted to determine the efficacy of intralesional triamcinolone in augmenting results of endoscopic dilation in corrosive esophageal strictures. Methods: Seventeen patients with corrosive esophageal strictures were treated with endoscopic dilation together with injection of triamcinolone acetonide into the stricture. Fourteen patients were already undergoing dilation; 3 patients were newly recruited. The interval between dilations and frequency of dilation were calculated before and after corticosteroid injections, and periodic dilation index was calculat- ed as number of dilations/number of months. Results: The mean age of the 17 patients (8 men and 9 women) was 30 ± 9.21 (range 13 to 52). Thirteen had strictures due to acid ingestion, four to alkali ingestion. There were 18 strictures in total, involving the upper (n = 2), middle (n = 10), and lower (n = 6) thirds of esophagus. Fourteen patients already on a dilation program had under- gone 27.92 ± 28.63 (range 6 to 92) dilations over a period of 22.92 ± 30.73 months (range 2 to 96) before corticosteroid injections. Nine patients received a single injec- tion of triamcinolone, whereas four each had two and three sessions. The dilation requirement after injections in these 14 patients was reduced to 3.57 ± 2.90 (range 0 to 10) dilations over a period of 10.5 ± 5.58 (range 4 to 21) months. The median total periodic dilation index irrespective of corticosteroid therapy was 0.33 (range 0.55 to 1.8). In 12 of the 14 patients, periodic dilation index before injections (range 0.91 to 3.0, median 1.67) was higher than the median total periodic dilation index and in all the 14 patients periodic dilation index after corticosteroid therapy (range 0 to 0.83, median 0.32) was less than the median of total periodic dilation index (p < 0.01). In addition three patients received intralesional corticosteroid injections at the time of first dila- tion. These three patients could be effectively dilated with 5, 3, and 3 dilations. Conclusions: Intralesional triamcinolone injections augment the effects of endo- scopic dilation in patients with corrosive esophageal strictures. (Gastrointest Endosc 1999;49:509-13.) Received October 11, 1997. For revision April 15, 1998. Accepted December 5, 1998. From the Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Presented at the annual meeting of the American Gastroen- terology Association, New Orleans, Louisiana, May 17-20, 1998. Reprint requests: R. Kochhar, MD, DM,Additional Professor, Dept. of Gastroenterology, PGIMER, Chandigarh-160012, India; fax: 91-172-540401. Copyright © 1999 by the American Society for Gastrointestinal Endoscopy 0016-5107/99/$8.00 + 0 37/1/96352 VOLUME 49, NO. 4, PART 1, 1999 GASTROINTESTINAL ENDOSCOPY 509