Efficacy of fully-covered nitinol self-expandable metal stent for benign esophageal disorders in children

Abstract

Objective To explore the feasibility and efficacy of fully-covered nitinol self-expandable metal stent (SEMS) for refractory benign esophageal disorders in children. Methods From May 2009 to June 2017, 10 children with refractory benign esophageal disorders were recruited. Specially designed SEMS was applied for chemical corrosive injuries (n=7), cardiac achalasia (n=2) and esophageal perforation after inappropriate balloon dilatation (n=1). The clinical data, including symptom remission, complications and stricture diameters, were collected during regular follow-ups. Results A total of 14 stents were successfully implanted for 2-3 months. Seven cases were implanted once and another 3 cases more than once. During a follow-up period of 6-58 months, one child aged 4 years had stent removed due to excruciating pain. Dysphagia became obviously alleviated in another 9 patients. And Ogilvie & Atkinson’s dysphagia score improved from grade Ⅲ-Ⅳ to grade 0-Ⅰ and diameters of stenosis expanded from 2-5 to 9-15 mm. Two cases of corrosive chemical injuries developed recurrent stricture within 3 months after stent removal. Slight growth of granulation tissue occurred in 1 case. For 2 cases of cardiac achalasia, vomiting improved continuously and another stent was unnecessary. In one case of esophageal fistula, poor adherence to esophagus occurred within 1 week post-stenting. Then another redesigned SEMS with a larger proximal tip was implanted in the same place. Two months later, fistula healed after stent removal. Conclusions Fully-covered nitinol SEMS is both safe and effective for treating refractory benign esophageal stricture in children. Stents must be customized for esophageal strictures. And postoperative complications should be handled diligently and timely. Key words: Esophageal stenosis; Stent; Digestive endoscopy