Clinical Report: Oral Viscous Budesonide for Maintenance Therapy Decreases Recurrence of Dilation Following Esophageal Atresia Surgery

Overview

This study demonstrates that oral viscous budesonide (OVB) maintenance therapy significantly reduces the recurrence of dilation in children with recurrent anastomotic stricture (AS) after esophageal atresia (EA) repair. The findings suggest that OVB may serve as an effective disease-modifying strategy in this patient population.

Background

Recurrent anastomotic stricture is a common complication following esophageal atresia repair, affecting up to 40% of patients in the first year of life. This condition can lead to significant morbidity, including impaired feeding and quality of life, necessitating repeated endoscopic dilations. Current treatment strategies primarily focus on mechanical dilation, highlighting the need for more effective, disease-modifying therapies.

Data Highlights

Key Findings

• OVB maintenance therapy resulted in a dilation-free survival of 91% compared to 50% in the control group at 6 months (p = 0.037).
• Dilation recurrence occurred in 25% of patients receiving OVB versus 70% in the control group (p = 0.043).
• The median time to recurrence was significantly longer in the OVB group (13 months) compared to the control group (7 months).
• OVB was independently associated with a lower risk of dilation (adjusted HR 5.68; 95% CI 1.08–27.4).
• Dysphagia scores were significantly lower in the OVB group.
• No systemic adverse effects were reported with OVB treatment.

Clinical Implications

The findings support the use of OVB as a maintenance therapy to prolong dilation-free intervals in children with recurrent AS after EA repair. Clinicians should consider incorporating OVB into treatment plans for patients at risk of stricture recurrence to improve long-term outcomes.

Conclusion

Maintenance therapy with oral viscous budesonide significantly reduces the recurrence of dilation in children with recurrent anastomotic stricture after esophageal atresia surgery, indicating its potential as a disease-modifying treatment.

Related Resources & Content

1. The New Gastroenterologist, Source, 2025 -- Long-Term Findings Endorse Reduced-Dose Maintenance Therapy for Eosinophilic Esophagitis
2. The New Gastroenterologist, Source, 2025 -- Extended Treatment for Eosinophilic Esophagitis Reduces Relapse Risk Without Increased Complications
3. Journal of Gastroenterology, 2017 -- Efficacy of Twice-Daily 2-Mg Budesonide Foam in Achieving Full Mucosal Healing of Distal Lesions and Inducing Clinical Remission in Mild-to-Moderate Ulcerative Colitis: A Double-Blind, Randomized Trial
4. Surgical Endoscopy, 2022 -- Comparative Effectiveness of Laparoscopic Antireflux Surgery versus Proton Pump Inhibitors for Treating Reflux-Induced Esophageal Strictures
5. SOCIETY GUIDELINE -- ESPGHAN-NASPGHAN Guidelines for the Evaluation and Management of Esophageal Atresia
6. Frontiers, 2021 -- The Safety of Intralesional Steroid Injections in Young Children and Their Effectiveness in Anastomotic Esophageal Strictures—A Meta-Analysis and Systematic Review
7. Frontiers, 2024 -- Efficacy of oral viscous budesonide to reduce dilation treatment after esophageal atresia repair: a retrospective study
8. SOCIETY GUIDELINE
9. Frontiers | The Safety of Intralesional Steroid Injections in Young Children and Their Effectiveness in Anastomotic Esophageal Strictures—A Meta-Analysis and Systematic Review
10. Frontiers | Efficacy of oral viscous budesonide to reduce dilation treatment after esophageal atresia repair: a retrospective study