Benign oesophageal strictures are primarily treated with endoscopic dilation; however, they may recur or fail to respond to treatment, requiring several additional intervention. Corticosteroid injection is a possible adjunctive therapy to decrease stricture formation. However, current literature remains inconsistent on this topic, highlighting the need for further evidence ^1,2. This study investigates the efficacy and safety of adding intralesional corticosteroid injection to dilation in patients with benign oesophageal strictures.

This is a retrospective observational comparative study over the last 15 years. Patients (>18 years of age) with benign oesophageal strictures, regardless of aetiology, treated with TTS balloon dilation with or without peri-procedural administration of 2 mg betamethasone per quadrant, were included. Exclusion criteria included achalasia, ongoing oesophageal inflammation, non-adherence to the dilation scheme, patients lost to follow-up, and patients treated with other types of dilations such as Savary-Gilliard or pneumatic dilators. The number of sessions needed to achieve sufficient dilation (SUFD), defined as dilation up to 14 mm, the total number of dilations required (ND), sustained clinical improvement (SCI) defined as sufficient dilation + absence of dysphagia at 6 months, and the periodic dilation index (PDI), defined as the number of sessions needed over the total follow-up time, were assessed. Refractoriness was defined as the inability to achieve a 14 mm diameter after five sessions, and recurrent stenosis was defined as the inability to maintain a satisfactory luminal diameter for 4 weeks after reaching the 14 mm target diameter. To assess treatment safety, all complications resulting from dilation and/or intralesional corticosteroid injections were recorded.

Forty-five patients with benign oesophageal strictures were identified: caustic (12), radiation (12), peptic (11), anastomotic (7), eosinophilic esophagitis (2), and oesophageal rings (1). Of these patients, 7 were treated with dilation + corticosteroid injection (4 caustic, 1 eosinophilic esophagitis, 1 peptic, and 1 radiation), and the remainder were treated with dilation alone. A significantly lower ND was required for the corticosteroid compared to the non-corticosteroid group (2.86 ± 0.69 vs. 6.76 ± 3.82, p<0.001) and fewer SUFD were needed (1.14 ± 0.38 vs. 3.63 ± 2.48, p=0.002). SCI was observed in 100% of the corticosteroid group vs. 50% in the non-corticosteroid group (p=0.016). No statistically significant relationship with the incidence of complications was found, with only two major complications occurring in the non-corticosteroid group (perforation and fistulisation). Subgroup analysis by stricture type showed a trend toward better outcomes with corticosteroids (fewer ND, SUFD, no complications or refractoriness), but no statistical significance was observed in the eosinophilic, peptic, and radiation subgroups due to their small size. In caustic strictures, the use of corticosteroids was associated with significantly lower ND and SUFD (p=0.015 and 0.017, respectively). All patients treated with corticosteroids achieved SCI, although without statistical significance (p=0.208).

Intralesional corticosteroid injection as an adjunct to endoscopic dilation was associated with a significant reduction in the number of dilation sessions, faster achievement of target luminal diameter, and a marked improvement in sustained clinical outcomes, without an increase in complications. These benefits were particularly pronounced in caustic strictures, likely due to their predominantly fibro-inflammatory pathophysiology, characterized by intense inflammation and fibroblast activation with excessive collagen deposition—pathways directly inhibited by intralesional corticosteroids. In contrast, peptic, anastomotic, and radiation-induced strictures are dominated by more mature, avascular fibrosis, which may explain their lower responsiveness.

Our findings support corticosteroid injection as a safe, effective, and resource-sparing adjunctive therapy in selected patients with benign oesophageal strictures. Despite the retrospective design and limited subgroup sizes, this study provides robust real-world evidence of its clinical benefit. Prospective, adequately powered studies are warranted to further clarify its role across different stricture aetiologies.