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

Gastrointest Endosc. 2010 Dec;72(6):1201-8. doi: 10.1016/j.gie.2010.08.003. Epub 2010 Oct 16.


Background: Endoscopic balloon dilation (EBD) is an attractive conservative therapy for Crohn's disease (CD) with stricture; however, its long-term efficacy has been questioned because many patients require more dilations or postdilation surgery. Most reports are retrospective, and no pediatric data are available.

Objective: To assess the effectiveness of corticosteroid intralesional injection after EBD in preventing stricture recurrence.

Design: Single-center prospective, randomized, double-blind, controlled trial.

Setting: Tertiary-referral university hospital.

Patients: Between November 2005 and January 2009, 29 pediatric patients with stricturing CD were enrolled.

Interventions: Enrolled patients were randomized to receive intrastricture injection of corticosteroid (CS) (n = 15) or placebo (n = 14) after EBD. Patients were followed clinically via small intestine contrast US and intestinal magnetic resonance imaging at 1, 3, 6, and 12 months; all underwent colonoscopy 12 months after dilation.

Main outcome measurements: Time free of repeat dilation and time free of surgery in the 2 groups.

Results: One of the 15 patients receiving CS required redilation, whereas the latter was needed in 5 of the 14 placebo patients; surgery was needed in 4 of the placebo patients, but in none of those receiving CS. The 2 groups statistically differed in the time free of redilation (P = .04) as well as for time free of surgery after EBD (P = .02), which were worse in the placebo group compared with the CS group. There were no significant differences in baseline demographics between the 2 groups.

Limitations: Sample size, participation bias, and short-term follow-up.

Conclusion: In pediatric CD with stricture, intralesional CS injection after EBD is an effective strategy for reducing the need both for redilation and surgery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents / administration & dosage*
  • Catheterization*
  • Child
  • Colonoscopy
  • Combined Modality Therapy
  • Crohn Disease / therapy*
  • Double-Blind Method
  • Endoscopy, Gastrointestinal*
  • Female
  • Follow-Up Studies
  • Humans
  • Ileal Diseases / diagnosis
  • Ileal Diseases / therapy*
  • Injections, Intralesional
  • Intestinal Obstruction / diagnosis
  • Intestinal Obstruction / therapy*
  • Jejunal Diseases / diagnosis
  • Jejunal Diseases / therapy*
  • Magnetic Resonance Imaging
  • Male
  • Prospective Studies
  • Recurrence
  • Triamcinolone / administration & dosage*


  • Anti-Inflammatory Agents
  • Triamcinolone