Injecting Steroids Into Strictures

Steroid injection is framed as an adjunct after competent dilation, not a shortcut around it. For complex peptic strictures that are long, tight, or tortuous, the lecture stresses frequent early redilation before adding agents, stents, or needle-knife work. When several dilations still leave a rapidly recurring tight lumen, triamcinolone (commonly 40 mg/mL) is injected after dilation: about 1 mL total, often 0.25 mL in four quadrants so the drug spreads circumferentially. Practical tips include using a small syringe so you can meter tiny aliquots, avoiding large-volume dilution, and injecting after (not before) dilation so swelling does not obscure wire and lumen control. The session is Q&A style and compares how often to repeat steroid sessions (often two to three) while watching clinical response.