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Intralesional steroids beneficial after Crohn’s stricture dilation in children

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – After endoscopic balloon dilation of intestinal strictures in children with Crohn’s disease, an intralesional injection of triamcinolone reduces the rate of recurrence, according to the results of a small randomized study conducted in Italy.

Dr. Salvatore Cucchiara with “Sapienza” University of Rome and University Hospital Umberto I, and colleagues report their findings in the October 18 online issue of Gastrointestinal Endoscopy.

They point out that endoscopic dilation is an attractive alternative to surgery for dealing with stricturing Crohn’s disease, but a significant number of patients subsequently require redilation or surgery. While intramural corticosteroid injection is often used to prevent recurrence in other conditions such as caustic strictures, it has never been tried in pediatric Crohn’s disease.

The team therefore tested the approach in 29 children, mean age 14.5 years, with stricturing Crohn’s disease. After endoscopic balloon dilation, 15 patients received an intralesional injection of 40 mg triamcinolone while 14 were given a placebo injection.

During follow-up for a year, only 1 of the 15 patients given triamcinolone required redilation, whereas it was necessary for 5 of the 14 placebo patients, the investigators reports

Furthermore, 4 of the 14 patients receiving placebo required surgery compared with none of the 15 patients receiving corticosteroids.

The reduction in the need for redilation or surgery “is of great value in improving quality of life and decreasing hospitalization costs in such a chronic unremitting disease that represents a striking burden for affected children and an obvious challenge for physicians,” Dr. Cucchiara and colleagues write.

However, they conclude, “Whether the results of this study represent a temporary amelioration or a stable effect is still undetermined. By prolonging the follow-up period, future studies should clarify this issue.”


Intralesional steroid injection after endoscopic balloon dilation in pediatric Crohn’s disease with stricture: a prospective, randomized, double-blind, controlled trial

Gastrointest Endosc 2010