Benign Esophageal Strictures In Children Research Articles

Esophageal dilation through bouginage or balloon catheters in children, as the treatment of benign esophageal strictures: results, considering the etiology, and the methods.

Corrosive substance ingestion, history of esophageal surgery, and reflux esophagitis are the main causes of benign esophageal strictures in children. Esophageal dilation is the first treatment option. Bougies and balloons are the most frequently used dilation tools. The literature record on esophageal dilation methods and their results is mostly composed of data gathered from adults, who differ from children in many terms, including etiology, indications, and results. This study aims to evaluate esophagial dilation in children; comparing the two mentioned modalities; and considering the impact of different diseases on dilation success. The benign esophageal stricture cases who had undergone esophageal dilation between 2001 and 2009, at two tertiary health-care centers of a university were evaluated retrospectively with regard to stricture etiology, treatment methods, and their results. In addition, balloon and bougie dilations were compared. Fifty-four cases were dilated in 447 sessions. The strictures were due to corrosive ingestion or anastomoses in 72.2% of the cases. Of the dilation sessions, 52.6% were performed with Savary-Gilliard bougies, and the rest with balloon dilators. No guidewire was needed in 53.2% of the bougie sessions. Fluoroscopy was used during balloon dilation sessions as a routine part of the method, while it was needed only to check the guide location when needed during the bougie dilation sessions. The complication rates of balloon and bougie dilation sessions were 2.4% and 2.1%, respectively. The mean session length was 26.2±11.8 and 42.6±13.7 min, for bougie and balloon, respectively. Success rate was 93.7% for the balloon, while 98.2% of the bougie sessions. Balloon catheters used were disposable. Savary-Gilliard bougies have advantages over balloon catheters with less need of fluoroscopy, shorter duration of sessions, and lower cost. Both methods are equivalently safe with close complication rates.

Fluoroscopy-guided balloon dilatation of benign esophageal strictures in children: 11-year experience.

The esophageal stricture is an important clinical problem in children, and the treatment is difficult. To evaluate the results of fluoroscopy-guided balloon dilatation of benign pediatric esophageal strictures and to suggest a safety range for balloon diameters. We retrospectively reviewed the medical records of children who underwent fluoroscopy-guided esophageal balloon dilatation for treatment of benign esophageal stricture from February 2008 to July 2019. We recorded the demographic data of the children, technical details of each procedure, balloon diameter, number of repeated procedures, clinical and technical success rates, complications and follow-up period. Technical success was defined as the disappearance of the waist formation on the balloon catheter, and clinical success was defined as no need for re-dilation or other treatment methods during the 1-year follow-up after the procedure. These children were divided into groups and evaluated according to esophageal stricture etiology. Technically successful procedures included 375 balloon dilatations in 116 patients (67 boys; age range: 1month to 18years; mean age: 4.3 ± 4.8 standard deviation [SD] years at the initial dilatation). The follow-up period was 1-138months (median: 41months; mean: 44months) since the last dilatation. In this study, the clinical success rate was 34% per procedure (120 of 353 procedures) and 85% per patients (91 of 107 patients). The total complication rate per procedure was 0.5%, and the perforation rate was 0.25% per session. Fluoroscopy-guided esophageal balloon dilatation is an effective and reliable method for treating benign esophageal strictures in children.

New therapies for esophageal strictures in children.

The present review aims at describing recent advances in therapeutic strategies for the treatment of benign esophageal strictures in children. We discuss current knowledge and practice on esophageal dilations, which are still the mainstream of treatment. We present new evidence about adjuvant treatments for recurrent and refractory strictures, including endoscopic incisional therapy, esophageal stenting, intralesional or topical mytomicin C and intralesional, systemic or topical steroids. Current evidence on esophageal dilations is not sufficient to establish superiority of one of the available techniques, especially the use of balloon or bougie dilators, but a prospective international cohort study on anastomotic stricture in esophageal atresia is underway to address this issue. Recurrent and refractory strictures still represent a challenge, since none of the adjuvant pharmacological and mechanical interventions has shown to be enough feasible, effective and safe to revolutionize clinical practice. In the last couple of years, several encouraging results have been published on management of esophageal strictures in children. Further research is needed, hopefully directed toward secure, easily reproducible and minimally invasive measures.

The Most Common Causes of Benign Esophageal Stricture in Children and the Success Rate of Endoscopic Balloon Dilatation, a Single-Center Experience

Background: Benign esophageal strictures are not rare. Over the past two decades, endoscopic balloon dilatation (EBD) has been used to treat them. Objectives: The purpose of this study was to identify the most common causes of benign esophageal stricture in children determine the success rate of endoscopic balloon dilatation. Methods: Children younger than 16 years with benign esophageal strictures referred to the endoscopy department during one year (2016 - 2017) were enrolled. After obtaining written consent from parents, endoscopy balloon dilatation was performed with two types of balloon catheters. Response to treatment was evaluated based on clinical symptoms and was classified according to the Vantrappen table score. Results: In this study, thirty-one (31) children participated including 19 (61%) boys and 12 (39%) girls. The mean age was 5.1 ± 3.9 years. The most common causes of esophageal stricture were: achalasia (45%), esophageal atresia (19%), stenosis due to the caustic ingestion (19%), another congenital stenosis (16%). Overall, 27 children (87.1%) had a good response to treatment. In children with stenosis due to caustic ingestion, the inappropriate response was higher than the rest (33%). However, only in 4 (12.9%) patients, balloon dilatation failed. No complications were observed. Conclusions: Achalasia, esophageal atresia, and caustic ingestion are the most common cause of benign esophageal stricture in the children. EBD is an effective and safe treatment in these children, even in cases of previous surgery and recurrence. If this procedure is performed by an expert using appropriate balloon catheters, no complications will be created.

Therapeutic effect of endoscope-guided bougie dilatation on benign esophageal stricture in children

Objective To investigate therapeutic effect of endoscope-guided bougie dilatation on children with benign esophageal stricture. Methods Data of 71 patients with benign esophageal stricture were retrospective analyzed.Patients were divided into group A (reflux stricture), B (congenital esophageal atresia stricture) and C (caustic injuries stricture), based on different causes. The expansion effectiveness and factors of the three groups were analyzed. Results A total of 885 expansions were performed on 71 patients with the total efficacy rate 94.37%(67/71). No statistic differences were shown in expansion effectiveness among the 3 groups; group C(14.9 times/case, P<0.05)showed more expansion frequencies than group A (9.1 times/case, P<0.05)and group B(10.7 times/case, P<0.05), more complications than group A(1.22% VS 0, P<0.05) and group B(1.22% VS 0.31%, P<0.05). Conclusion Endoscope-guided bougie dilatation is safe and effective for childrens′ benign esophageal stricture. Caustic injuries, refractory benign esophageal stricture, need more expansions and may be accompanied with more complications. Key words: Children benign esophageal stricture; Endoscope-guided dilatation; Effectiveness; Risk factor

A reliable animal model to simulate benign esophageal strictures in children

Background Benign esophageal strictures are common among children, especially children under 5 years of age. There is no standard treatment for refractory benign esophageal stricture, and it is quite challenging to care for children. The aim of this research is to establish an animal model of benign esophageal stricture with a custom balloon catheter, offering a cornerstone for exploring effective treatment methods.

The use of retrievable fully covered self-expanding metal stent in refractory postoperative restenosis of benign esophageal stricture in children

PurposeThis study analyzes the efficacy and safety of a retrievable, fully covered self-expanding metal stent (cSEMS) in the treatment of refractory benign esophageal restenosis in children. MethodsThis is a retrospective analysis of the application of a newly designed cSEMS in treating refractory benign postoperative restenosis in five children with ages ranging from 16months to 8years. Efficacy and safety were evaluated during the follow-up period. ResultscSEMS with or without an antireflux valve at the distal end were successfully placed and removed in five children. These five patients were followed up for 4–12months after stent removal. Among the five patients, ulcerative stricture was observed in two patients because of reflux esophagitis, while three patients showed no signs of stricture recurrence. Stent migration was observed in three patients, two of which required the stent to be reset. The narrow esophagus was successfully expended to a diameter of 12–13mm. Besides the observation of mild granulation tissue growth in one case, no severe complications were observed during surgery and after stent placement. ConclusionOur study suggests that a retrievable, fully covered SEMS is safe and partially effective for treating refractory benign postoperative esophageal restenosis in children during short-term observation.

Refractory strictures post-esophageal atresia repair: what are the alternatives?

Esophageal strictures remain the most frequent complication after esophageal atresia (EA) repair despite refinements in operative techniques. With an incidence of anastomotic stricture between 8% and 49%, EA is the most frequent cause of benign esophageal stricture in children. The mainstay of treatment for esophageal stricture is dilatation with a 58-96% success rate. In order to relieve dysphagia, between 1 and 15 dilatations will be required in each EA patient with an esophageal stricture. However dilatations may lead to complications including perforation (0.1-0.4% of all esophageal benign strictures) and sociopsychological morbidity. Fifty percent of EA strictures will improve in 6 months. However, 30% will persist and require repeat dilatations. The present article explores the variety of non-surgical alternative treatments for anastomotic strictures after EA repair, focusing on triamcinolone acetonide, mitomycin C and esophageal stents. We propose an algorithm for a more standardized therapeutic approach, with the hope that an international panel of experts could meet and establish a consensus.

Flouroscopy Guided Balloon Dilatation of Benign Esophageal Strictures : A Single Center Study

Objective: To review the efficacy and safety of balloon dilatation among children with benign esophageal strictures. Methods: This is a retrospective review of 209 balloon dilation procedures performed under fluoroscopy guidance on 66 patients (38 male and 28 female) with benign esophageal strictures over 27 months (January 2009 to March 2011). The study was conducted at King Hussein Medical Centre. Patients had a mean age of 26 months and a median of 3.2 (1-18) dilatations. Immediate technical success was defined as the ability to dilate the stricture without complications. Long term success was defined as the disappearance of presenting symptoms for a minimum of 12 months post procedure. All patients had the procedure performed under general anesthesia with pre and post procedure esophagogram. Simple descriptive statistics (frequency, mean and percentage) were used to describe the study variables. Results: Immediate technical success was noted in 208 procedures (99.5%). Esophageal perforation was encountered in one patient at the fifth dilatation session (type1 perforation). Long term success was achieved in 44%, 42% and 14% of cases following a single, two to five and more than five interventions consecutively. Conclusion: Fluoroscopy-guided balloon dilatation procedure is a simple, safe and efficacious modality for treatment for benign esophageal strictures in children, with low rate of complications.

Evaluation von Stents zur Behandlung der benignen Ösophagusstenose im Kindesalter

Esophageal stenting is a popular of treatment of esophageal strictures in adults. It has also been described for children with benign strictures who did not respond to standard dilatation therapy. The aim of the study was to evaluate weather esophageal stents could be used safely and effectively in the treatment of benign esophageal strictures in children. From 1993 to 2005 stenting therapy was performed in 12 children with complicated esophageal strictures. Etiologies of the strictures were caustic burns in 9 patients, postoperative strictures due to complicated esophageal atresia in 2 patients and iatrogenic esophageal injury in 1 patient. Esophageal silicon tubi, covered retrievable expandable nitinol and plastic stents were placed endoscopically. The clinical course and the long term follow up were evaluated retrospectively The stents and tubi were placed in all patients without complications and were later removed successfully. 6 patients were treated with a self expanding plastic stent. The plastic stents showed a distinct tendency to migrate but in 5/6 patients esophageal stricture was treated successfully. 3 patients were treated by a covered self expanding nitinol stent. No migration occurred. One patient was asymptomatic after therapy, one required further dilatation therapy and the third had esophageal resection. 3 patients were treated by esophageal tubi. 2 patients required surgery in the follow up, one patient is asymptomatic. The use of stenting devices in children to treat benign esophageal strictures is safe and efficient. The self expanding plastic stents had the best long term results but required high compliance of parents and children due to the tendency of stent migration. Self expanding nitinol stents are more traumatic at the extraction procedure and are useful in patients with low compliance. Recurrence of strictures occurred most often after esophageal tubi possibly due to the lack of radial expansion.

Balloon Catheter Dilatation of Benign Esophageal Strictures in Children

This retrospective study evaluated the safety and efficacy of fluoroscopically guided balloon dilatation of benign pediatric esophageal strictures. Between 2000 and 2005, 272 esophageal balloon dilatations were performed in 49 children, aged 18 days to 18 years. Chart and primary physician record reviews were used to assess complications, age-appropriate food intake, and dysphagia. Efficacy was calculated by time to recurrent symptoms requiring repeat balloon dilatation. Durability was assessed by the frequency of dilatations. Seventy-seven percent of patients required a second dilatation within 9 months. Survival analysis (Kaplan-Meier) demonstrated no significant difference for efficacy in relation to patient age (P = .76) or stricture cause (P = .56). A decrease in the number of dilatations occurred over time to achieve longer symptom-free intervals. Patients underwent an average of 5.6 dilatations with an average total intervention time of 2 years. Patients were able to remain symptom free for a mean of 110 days. The procedure had a success rate of 100%, the only major complication being an esophageal perforation (complication rate, 0.37%) in a patient with a stricture secondary to correction of a tracheoesophageal fistula. Balloon esophageal dilatation in children is an effective and safe first-line therapy. Complications are quite rare and manageable. Although cures are unusual, most children require less than one dilatation every 6 months. It is concluded that fluoroscopically guided balloon dilatation should be the primary method of treating benign esophageal strictures.

Benign esophageal strictures in children and adolescents: etiology, clinical profile, and results of endoscopic dilation

Background: The problem of dysphagia in children and adolescents differs from that in adults, and therefore requires special consideration. Methods: Forty-one consecutive children and adolescents 16 years of age or younger (mean, 7.2 years), with benign esophageal strictures were evaluated in a prospective manner over a 7-year period. The most frequent causes of esophageal strictures were caustic ingestion and complications of endoscopic sclerotherapy of esophageal varices. Dilation was done on a weekly basis using bougies and was considered adequate if the esophageal lumen could be dilated to 15 mm diameter (11 mm in children less than 5 years old) with complete relief of dysphagia. Results: Of the 30 patients who could be adequately followed after initial dilation, 16 had corrosive strictures and 14 had strictures due to other causes. Patients with corrosive strictures required a significantly higher number of sessions for adequate initial dilation (7.8 ± 2.5 sessions vs 1.86 ± 0.48 sessions; p < 0.01). Patients with corrosive strictures had a higher number of mean symptomatic recurrences per patient month as compared to the noncorrosive stricture group (0.15 ± 0.01 vs 0.087 ± 0.03, p < 0.01). Six esophageal perforations occurred during a total of 327 dilation sessions (1.8%); there was one fatality. Conclusions: From our experience, we conclude that benign esophageal strictures in young patients can be treated effectively and with acceptable safety by means of endoscopic dilation. (Gastrointest Endosc 1996;43:474-7.)

Balloon dilation of esophageal strictures in children

Esophageal strictures in children may develop as a primary constriction, secondary to a surgically repaired esophageal atresia (with or without tracheoesophageal fistula), as a result of chemical injury after caustic ingestion, or following esophageal surgery. Traditional treatment of esophageal strictures has been limited to dilation (using bougie dilators) with esophagoscopy under general anesthesia. Recent reports have shown success with fluoroscopically guided ballon catheter dilation. Eight children (aged 2 months to 14 years) were treated with balloon catheter dilation for focal strictures of the esophagus. In six of the eight cases, complete resolution of the strictures was achieved after an average of 7.5 dilations (range, 1 to 14). Two of the eight patients moved to another part of the country and did not complete treatment. There has been no morbidity or mortality. In selected centers, balloon catheter dilation under fluoroscopic guidance has become a safe treatment of benign esophageal strictures in children. It should be considered the treatment of choice in the initial management of esophageal narrowing and appears to safer than the more traditional methods of esophageal dilation.

Benign esophageal strictures in children and adolescents: etiology, clinical profile, and results of endoscopic dilation

<h2>Abstract</h2> <i>Background</i>: The problem of dysphagia in children and adolescents differs from that in adults, and therefore requires special consideration. <i>Methods</i>: Forty-one consecutive children and adolescents 16 years of age or younger (mean, 7.2 years), with benign esophageal strictures were evaluated in a prospective manner over a 7-year period. The most frequent causes of esophageal strictures were caustic ingestion and complications of endoscopic sclerotherapy of esophageal varices. Dilation was done on a weekly basis using bougies and was considered adequate if the esophageal lumen could be dilated to 15 mm diameter (11 mm in children less than 5 years old) with complete relief of dysphagia. <i>Results</i>: Of the 30 patients who could be adequately followed after initial dilation, 16 had corrosive strictures and 14 had strictures due to other causes. Patients with corrosive strictures required a significantly higher number of sessions for adequate initial dilation (7.8 ± 2.5 sessions vs 1.86 ± 0.48 sessions; <i>p</i> < 0.01). Patients with corrosive strictures had a higher number of mean symptomatic recurrences per patient month as compared to the noncorrosive stricture group (0.15 ± 0.01 vs 0.087 ± 0.03, <i>p</i> < 0.01). Six esophageal perforations occurred during a total of 327 dilation sessions (1.8%); there was one fatality. <i>Conclusions</i>: From our experience, we conclude that benign esophageal strictures in young patients can be treated effectively and with acceptable safety by means of endoscopic dilation. (Gastrointest Endosc 1996;43:474-7.)