Esophageal Stenosis Clinical Trial
Official title:
Corticosteroid Treatment in the Acute Phase of Caustic Ingestion Management for the Prevention of Refractory Stenosis of the Esophagus and Pharynx- The CORTICAU Study
The management of patients who have ingested a caustic product has changed since 2007.
Whereas previously the lesion assessment and surgical indication were based on endoscopic
data, the therapeutic algorithm is currently based solely on the results of a CT scan with
contrast injection, performed 6 hours after ingestion. This examination makes it possible to
reliably assess the viability of the esophageal and gastric walls and thus to indicate
digestive resection. The therapeutic consequences of this new treatment are important
because, by expanding the indications for conservative treatment after severe ingestion, it
brings a significant gain in terms of survival, morbidity and functional outcome. In the
absence of emergency digestive resection, however, the functional prognosis is often
overshadowed by the formation of esophageal stenosis in the months following ingestion.
Patients then require endoscopic dilation treatment. In the event of failure or impossibility
of dilation, which defines refractory stenosis, esophageal reconstruction is necessary. In
case of sequential pharyngeal stenosis following ingestion, esophageal and pharyngeal
reconstruction is indicated as a first-line treatment, since these stenosis do not respond to
endoscopic dilations. The expansion of the indications for conservative treatment after
severe ingestion using CT scans has led to an increase in the incidence of after-effect
stenosis.
We aim to develop a therapeutic approach that will prevent the development of refractory and
pharyngeal esophageal stenosis. Indeed, there is currently no strategy that has proven
effective in this regard in adults. The value of corticosteroid therapy for the prevention of
caustic stenosis has only been evaluated in children and remains controversial.
The main objective is to evaluate the effect of early systemic corticosteroid therapy on the
risk of refractory esophageal or pharyngeal stenosis within one year of ingestion of a
caustic substance in a population of patients at high risk of stenosis, defined according to
tomodensitometric criteria (grade IIb: severe lesions, absence of transparietal necrosis),
and for whom there is no indication of urgent digestive resection.
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