Rebecca Voaklander, MD1, John Fang, MD2; 1University of Utah, Salt Lake City, UT; 2University of Utah School of Medicine, Salt Lake City, UT
Introduction: Dilation combined with intralesional steroid injection is part of treatment algorithms for refractory upper gastrointestinal strictures. Few complications of this technique have been reported. We report two patients with infectious abscesses as a complication of steroid injection and dilation for benign, refractory upper gastrointestinal strictures.
Methods: Case 1: A 71-year-old woman with, GERD, NSAID use, Sjogren’s syndrome on azathioprine and refractory proximal esophageal stricture underwent her first intralesional steroid injection (triamcinolone 80 mg) combined with Savary dilation to 12.8mm. She had 22 previous dilations over 7 years without complication. The patient developed odynophagia 5 days later and was treated with topical and systemic analgesia. She developed neck swelling 11 days after the procedure and was found on CT to have bilateral neck abscesses. She was admitted to the ICU and treated with abscess aspiration, parenteral antibiotics and nasoenteric tube feeding. She was discharged with oral antibiotics and a soft diet on hospital day 7. She was readmitted with abscess recurrence 13 days later and parenteral antibiotics and tube feeding were resumed. ENT performed laryngoscopy, neck exploration and abscess drainage with drain placement. Esophagram demonstrated no perforation. The patient was discharged on a soft diet and oral antibiotics. She has subsequently resumed serial dilations without steroid injection. Case 2: A 70-year-old woman with active tobacco use and PUD due to NSAIDs complicated by refractory pyloric stenosis developed worsening epigastric pain and intractable nausea 6 weeks after her ninth intralesional steroid injection (triamcinolone 80 mg) combined with balloon dilation to 20mm. She was found on CT to have small abscesses in the pyloric wall. She was hospitalized and managed with parenteral antibiotics and discharged on hospital day 3 with oral antibiotics. She continues to have her pyloric stenosis managed with serial dilations without steroid injection. Discussion: Steroid injection combined with dilation is a useful therapeutic option for refractory upper gastrointestinal strictures. Abscess development has not been previously reported as a complication of this procedure. Endoscopists should be aware of the possibility of this significant complication when assessing patients with delayed post-procedural symptoms after dilation with steroid injection.
Disclosures: Rebecca Voaklander indicated no relevant financial relationships. John Fang indicated no relevant financial relationships.