Benign Esophageal Strictures Research Articles

Comparison between Balloon & Savary Dilatation in Management of Benign Esophageal Strictures in Pediatrics

Abstract Background Esophageal strictures are seldom in children. In many countries, accidental ingestion of corrosives is a major cause of risk for stricture formation. Therefore, their management is a challenge. Safety and long-term efficacy of esophageal dilation for benign esophageal strictures has been confirmed in children. Aim and Objectives The aim of this study was to perform a systematic review and a meta-analysis about literature published in the period from 2010-2020 comparing between balloon & savary dilatation in benign esophageal strictures in pediatric age group. Subjects and Methods This systematic review and meta-analysis included 5 retrospective studies fulfilled eligibility criteria, with a total of 353 cases were included with mean age 8 years and m\f was 200\153. Results 5 studies compare success between ballon and savary dilatation showed that there were insignificant differences between two group p-value 0.052 Conclusion The efficacy and complication rates of bougie and dilation are similar. Considering this level of evidence 1A study, we can state that there is no significant difference between methods to recommend one over the other. However, all the confounding factors and limitations should be considered.

Clinical outcomes of drug-coated balloons dilatation for benign esophageal stricture

BackgroundDrug-coated balloons (DCBs) angioplasty is safe and effective for coronary artery disease. However, DCBs dilatation for the treatment of benign esophageal strictures is rarely reported.PurposeWe aimed to report the clinical outcomes of DCBs dilatation for patients with benign esophageal strictures.MethodsFrom May 2020 to August 2023, 18 patients underwent DCBs dilatation for benign esophageal strictures. Baseline demographics were recorded and evaluated, including gender, age, comorbidities, stricture diameter and length, dilatation session, complications.ResultsA total of 24 dilatation sessions of DCBs were performed, with a mean of 1.3 ± 0.6 sessions per patients (range 1.0–5.0). Dysphagia score decreased significantly after DCBs dilatation (2.6 ± 1.1 vs. 0.9 ± 1.3, p = 0.0002). Both stricture diameter and stricture index decreased significantly after DCBs dilatation (p < 0.0001). No procedure-related death, massive bleeding or esophageal perforation was observed during or after DCBs dilatation. Minor complications were found in only 3 patients (16.7%). All 18 patients were successfully followed up for a median period of 12.0 months. By the end of follow up, 10 patients showed no dysphagia, 6 patients showed mild dysphagia and 2 patients showed no improvement in dysphagia. The clinical success rate of DCBs dilatation is 88.9%.ConclusionDCBs dilatation may be a safe, effective and feasible treatment for benign esophageal strictures, and can be utilized as an alternative option after standard dilatation has failed. Prospective studies with large samples are needed to further validate its clinical efficacy.

639. WHICH FACTORS LEAD PATIENTS WITH BENIGN ESOPHAGEAL STRICTURES FOR SURGICAL TREATMENT BESIDES ENDOSCOPIC TREATMENT?

Abstract Background This work proposes to evaluate patients with benign esophageal strictures, excluding caustic strictures, about their etiologies and poor prognostic factors for the success of endoscopic treatment. Methods It was evaluated in our service 38 patients, from 1992 to 2023, with benign esophageal strictures not related to caustic strictures. We could follow-up 24 patients from 7 months and 384 months (average of 136 months). Four died during the follow- up. We could analyze these following outcomes: clinical symptoms, surgical indications, age, gender, alcohol abuse, smoking, length of stricture, number of endoscopic dilation and stricture etiology. Results Concerning the 24 patients with follow-up, 4 had esophagectomy; 10 underwent endoscopic treatment with fundoplication and 10 were treated with endoscopic and medical treatment. Both groups, endoscopic and medical treatment, and endoscopic treatment with fundoplication had 4 patients that continued symptomatic (40%). The number of endoscopic dilations range from 1 to 101 (average 18) in each patient. The etiology of 38 patients with benign esophageal strictures were: 35 gastroesophageal reflux disease (13 Barrett´s esophagus); one with infectious esophagitis; one eosinophilic esophagitis and another due to esophageal varicose sclerosis. The prognostic factors to surgical treatment will be analyzed by statistical analysis. Conclusion From our data, it is possible to conclude that the endoscopic treatment is effective to manage the majority of benign esophageal strictures, even in association with fundoplication. Moreover, the main etiology was gastroesophageal reflux disease. Only few patients have developed indication to esophagectomy.

813. SELF-DILATATION FOR THE MANAGEMENT OF REFRACTORY BENIGN OESOPHAGEAL STRICTURES: OUTCOMES FROM THE LARGEST EUROPEAN TERTIARY CENTRE EXPERIENCE TO DATE

Abstract Background Benign oesophageal strictures are commonly encountered in endoscopy and are often effectively managed with endoscopic dilatation. However, up to 40% of patients may develop refractory benign oesophageal strictures (RBES), necessitating frequent endoscopic interventions that are often challenging, pose a greater risk of complications, and negatively impact quality of life. Oesophageal self-dilatation (SD) offers an alternative treatment that potentially reduces the need for repeat hospital visits while allowing patients greater autonomy in managing their condition. We describe the efficacy and safety of oesophageal SD at a tertiary referral centre. Methods We retrospectively reviewed the electronic records of patients with RBES (n=43) who were referred for SD to our centre between 2013 and 2024. The primary outcomes were the endoscopic dilatation-free interval (EDFI; longest period of time patients did not require endoscopic dilatation) and the number of endoscopic procedures performed within 12 months of starting SD. Secondary outcomes included the technical success rate of learning SD, improvement in the Dakkak and Bennett dysphagia score, and complications. Results are reported as median (interquartile range). Results 41/43 patients (median age 57 years) with various RBES aetiologies (32% peptic, 19.5% post-radiation, 12% post-surgical, 11.6% post-endoscopic resection, 24.9% other) and locations (24.4% proximal, 29.3% middle, 34.1% lower, 12.2% multi-segment) successfully learned SD. Median follow-up was 23.2 months. The EDFI increased from 68.5 (41-106) to 161 (121-279) days (P&amp;lt;0.001) while endoscopic interventions decreased from 7 (4.7-10) to 1 (0.75-3) (P&amp;lt;0.001) within 12 months before and after SD. The all-time EDFI was 405 days (130-705) and dysphagia score improved from 2 at baseline to 0 after SD. One patient experienced clinically significant haematemesis and one presumed SD-related oesophageal perforation. Conclusion To our knowledge, we have described the largest European case series of oesophageal SD that has been published to date. Oesophageal SD appears to be an effective, well-tolerated, and safe approach in managing often complex patients with RBES providing a viable alternative to conventional endoscopic interventions. However, the occurrence of adverse events highlights the importance of careful patient selection and ongoing monitoring. Further research is warranted to validate these findings and identify predictive factors for treatment success.

Efficacy and safety of radial incision and cutting for nonsurgical refractory benign esophageal stricture.

Background and study aims Radial incision and cutting (RIC) was established to improve refractory esophageal anastomotic strictures but its efficacy and safety for nonsurgical refractory strictures remain unclear. To evaluate the usefulness of RIC in nonsurgical refractory strictures, we retrospectively compared outcomes between nonsurgical and surgical strictures. Patients and methods We retrospectively studied 54 consecutive patients who were initially treated with RIC for refractory benign esophageal stricture. The study variables included dysphasia score improvement rate, frequency of repeated RIC, cumulative patency rate, cumulative stricture improved rate, and adverse events(AEs), which were compared between nonsurgical (n = 21) and surgical (n = 33) stricture groups. Results Immediately after RIC, 90.5% of patients in the nonsurgical group and 84.8% of patients in the surgical group had improvement in dysphagia ( P = 0.69). The frequency of intervening repeated RIC was 42.9% in the nonsurgical group and 42.4% in the surgical group ( P = 0.98). During median follow-up of 22.3 months (range, 1.0-175.0), the cumulative patency rate ( P = 0.23) and cumulative stricture improvement rate ( P = 0.14) but there was not statistical difference between the two groups. Despite a low cumulative stricture improvement rate (9.5%) at 6 months after the first RIC in the nonsurgical group, 57.7% of patients no longer required endoscopic balloon dilatation at 2 years. The cumulative stricture improvement rate was significantly lower in patients with a history of radiation therapy. No severe AEs were observed in the nonsurgical group. Conclusions RIC for nonsurgical refractory benign esophageal stricture is an effective and safe treatment option.

Abstract ID: 100Self-Dilatation for the Management of Refractory Benign Oesophageal Strictures: Outcomes from the Largest European Tertiary Centre Experience to Date

Abstract ID: 100Self-Dilatation for the Management of Refractory Benign Oesophageal Strictures: Outcomes from the Largest European Tertiary Centre Experience to Date

Esophageal Self-Dilation in Benign Refractory Esophageal Strictures: Outcomes from a Randomized Controlled Trial and a Prospective Observational Study

BackgroundPatients with benign esophageal strictures may not maintain a response to endoscopic dilation, stenting, incisional or injectional therapies. For patients with these refractory esophageal strictures, esophageal self-dilation therapy (ESDT), performed to maintain luminal patency, may provide persistent symptomatic benefit while reducing patients’ reliance on healthcare services and the risk associated with repeated endoscopic procedures.AimsThe aim of this study was to evaluate the efficacy and safety of EDST in a randomized controlled trial and prospective observational study.MethodsTwenty-five patients with refractory benign esophageal strictures were recruited at two esophageal clinics between November 2018 and June 2021. Twelve patients participated in the randomized trial and 13 in the prospective observational study. The number of endoscopic dilations, impact of therapy on dysphagia, adverse events, and complications were recorded.ResultsIn the randomized study, 50% of patients performing ESDT and 100% of controls required endoscopic dilation during follow-up (P = 0.02). In the observational study, the median (IQR) number of endoscopic dilations fell from 7 [7–10] in the 6 months prior to commencing ESDT to 1 [0–2] in the 6 months after (P < 0.0001). Most patients (22/25) were able to learn self-dilation. Few serious adverse events were noted. Dysphagia severity remained unchanged or improved.ConclusionsESDT appears to be a safe effective therapy for benign esophageal strictures refractory to endoscopic treatment.Clinical Trial NumberNCT03738566.

Update on applications of endoscopic cryotherapy in the gastrointestinal tract.

Endoscopic cryotherapy has emerged as a minimally invasive procedure for targeted tissue ablation within the gastrointestinal tract. This review aims to provide a comprehensive overview of current clinical applications of EC with a review of the pertinent literature. Endoscopic cryotherapy has demonstrated safety and efficacy for various gastrointestinal conditions. Recent studies have highlighted the efficacy of endoscopic cryotherapy, including both liquid nitrogen-based spray cryotherapy and the novel cryoballoon focal ablation system, in achieving complete eradication of dysplasia and neoplasia in Barrett's esophagus. Endoscopic cryotherapy has also shown promise as a second-line treatment option for patients with dysplastic Barrett's esophagus refractory to radiofrequency ablation and as an alternative to surgical resection for duodenal adenomas, when endoscopic resection is not feasible. Innovative applications for the treatment of gastrointestinal bleeding and management of benign refractory esophageal strictures have also been reported. Endoscopic cryotherapy represents a safe, effective, and well tolerated therapeutic option for various clinical scenarios in gastrointestinal endoscopy, including challenging disease states such as refractory Barrett's esophagus and advanced esophageal cancer. Advancements in cryotherapy technology and ongoing research continue to explore additional clinical indications and expand the role of endoscopic cryotherapy in patient care with an aim toward improved patient outcomes.

A novel self-inflatable balloon for treating refractory benign esophageal strictures: a prospective, single-arm, multicenter study.

Current treatments for refractory benign esophageal strictures (BESs) often take several years and have poor effects. The authors propose a novel method of self-help inflatable balloon (SHIB) and evaluate its efficacy and safety. A prospective, multicenter study was conducted from January 2019 to March 2022. All enrolled patients were diagnosed with refractory BESs and received SHIB. The primary endpoint was the clinical success rate at 12 months after removing SHIB. The secondary endpoints were the number of days of placing SHIB, and changes from baseline in BMI and health-related quality of life at 1, 3, 6, and 12 months. The clinical success rate was 51.2% (21/41) with the median days of placing SHIB being 104.0 days (range: 62.0-134.5 days), which was higher in the endoscopic group compared to the caustic and surgery groups (63.3 vs. 28.6% vs. 0, P=0.025). All patients (100%) showed significant improvement in dysphagia scores during placing SHIB. Although 20 patients (48.8%) experienced recurrent stricture, the median stricture length was decreased (P<0.001) and the median intervention-free interval was prolonged (P<0.001). In all patients, the mean BMI at and health-related quality of life at 1, 3, 6, and 12 months were significantly increased compared with baseline (P<0.05). On multivariate analysis, stricture etiology and wearing time were independent predictors of recurrent stricture. The SHIB has high efficacy and safety in treating refractory BESs of different origins, especially for endoscopic resection. Stricture etiology and wearing time were independent predictors of recurrent stricture.

Sporadic gastrinoma with refractory benign esophageal stricture: A case report

BACKGROUND Gastrinoma is characterized by an excessive release of gastrin, leading to hypersecretion of gastric acid, subsequently resulting in recurrent peptic ulcers, chronic diarrhea, and even esophageal strictures. This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture (RBES). Additionally, it highlights the persistent challenges that gastroenterologists encounter in managing RBES. CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy, multiple endoscopic bougie dilations and endoscopic incisional therapy (EIT). CONCLUSION It is essential to diagnose gastrinoma as early as possible, as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures. In patients with esophageal strictures causing complete luminal obstruction, blind reopening EIT presents challenges and carries a high risk of perforation.

Retrograde balloon pull-through technique for benign esophageal strictures: a single-center pilot experience

Retrograde balloon pull-through technique for benign esophageal strictures: a single-center pilot experience

Endoscopic ultrasonography features of benign esophageal stenosis in children

To investigate the endoscopic ultrasonography (EUS) features of benign esophageal stenosis in children. A retrospective analysis was conducted on the medical data of the children who were diagnosed with benign esophageal stenosis from February 2019 to February 2022. The clinical manifestations, EUS findings, and treatment outcome were analyzed to summarize the EUS features of benign esophageal stenosis in children. A total of 42 children with benign esophageal stenosis were included. Among these children, 19 (45%) had anastomotic stenosis after surgery for esophageal atresia, with unclear echogenic boundary of the esophageal walls and uneven thicknesses of the surrounding wall on EUS, and had 0-12 sessions of endoscopic treatment (average 2.1 sessions); 5 children (12%) had corrosive esophageal stenosis and 1 child (2%) had physical esophageal stenosis, with unclear stratification of the esophageal walls on EUS, and they had 2-9 sessions of endoscopic treatment (average 5.3 sessions); 1 child (2%) had patchy irregular hypoechoic areas of the esophageal walls on EUS and was diagnosed with tracheobronchial remnants with reference to pathology; 16 children (38%) had unexplained esophageal stenosis and unclear stratification of the esophageal walls on EUS, among whom 6 received endoscopic treatment. During follow-up, 95% (40/42) of the children had significant alleviation of the symptoms such as vomiting and dysphagia. For benign esophageal stenosis in children, EUS can help to evaluate the degree of esophageal wall involvement in esophageal stenosis lesions, possible etiologies, and the relationship between the esophagus and the lesion and provide an important basis for selecting treatment modality and avoiding complications, thereby helping to optimize the treatment regimen.

A Novel Rat Model to Simulate the Benign Esophageal Stricture Induced by Endoscopic Submucosal Dissection.

This study aimed to establish a rat model that simulates benign esophageal strictures induced by endoscopic submucosal dissection (ESD). Sixteen male Sprague-Dawley rats were randomly divided into mucosal resection (n = 8) and sham-operated groups (n = 8). The rats in the mucosal resection group underwent a 5-mm three-fourths mucosal resection by way of a 3-mm incision in the distal esophagus under direct visualization via laparotomy. Rats in the sham-operated group underwent a 3-mm incision of the muscularis propria layer in the distal esophagus via laparotomy without mucosal resection. Dysphagia score, weight gain, mucosal constriction rate, and histology were evaluated 2 weeks after surgery. Technical success was achieved in all the animals. One rat in the mucosal resection group died of infection, and no other complications were observed. Weight gain (P < 0.001) and luminal diameter derived from the esophagograms (P < 0.001) were significantly lower in the mucosal resection group than those in the sham-operated group. Dysphagia score (P < 0.001) and mucosal constriction rate (P < 0.001) were significantly higher in the mucosal resection group than those in the sham-operated group. The inflammation grade (P = 0.002), damage to the muscularis propria (P < 0.001), number of nascent microvessels (P = 0.006), and degree of α-SMA positive deposition (P = 0.006) were significantly higher in the mucosal resection group. A rat model of benign esophageal stricture induced by ESD was successfully and safely established by mucosal resection.

Paclitaxel-coated balloon catheter for benign esophageal stenosis in a rabbit model

Most patients with benign esophageal stenosis require multiple or even continuous balloon dilation treatments to achieve symptom relief. In this study, eighteen rabbits were used to establish an esophageal benign stenosis model and were divided into a control group (n = 6), a balloon group (n = 6) and a PTX-coated balloon group (n = 6) to evaluate the feasibility and effectiveness of paclitaxel (PTX)-coated balloons for the rabbit esophageal benign stenosis model. The weight and esophageal diameter were recorded every 2 weeks until 8 weeks post-surgery. Hematoxylin–eosin staining, Masson’s trichrome staining and immunohistochemical staining were performed for pathological analysis. Four weeks post-operation, there was a significant difference in weight between the control group and the balloon group (p = 0.01) and between the control group and the PTX balloon group (p = 0.01). There was a significant difference in the esophageal diameter between the balloon group and the PTX balloon group at 8 weeks post-operation (p = 0.02). Four weeks post-operation, the degree of inflammatory cell infiltration in the PTX balloon group was significantly lower than that in the control group (p = 0.002) and balloon group (p = 0.001). The degree of collagen deposition in the PTX balloon group was significantly lower than that in the control group (p = 0.002) and balloon group (p = 0.03). Eight weeks post-operation, the percentage of cells positive for TGF-β (p < 0.001), the degree of inflammatory cell infiltration (p = 0.02) and the degree of collagen deposition (p = 0.02) in the PTX balloon group were significantly lower than those in the balloon group. Therefore, PTX-coated balloons may alleviate the local inflammatory response and collagen deposition when used during dilation treatment of benign esophageal stenosis.

Comprehensive Assessment of Esophageal Disorders Associated with Hiatus Hernia: Insights from Big Data Analysis.

Hiatus hernia (HH) is a prevalent endoscopic finding in clinical practice, frequently co-occurring with esophageal disorders, yet the prevalence and degree of association remain uncertain. We aim to investigate HH's frequency and its suspected association with esophageal disorders. We reviewed endoscopic reports of over 75,000 consecutive patients who underwent gastroscopy over 12 years in two referral centers. HH was endoscopically diagnosed. We derived data on clinical presentation and a comprehensive assessment of benign and malignant esophageal pathologies. We performed multiple regression models to identify esophageal sequela associated with HH. The overall frequency of HH was (16.8%); the majority (89.5%) had small HHs (<3 cm). Female predominance was documented in HH patients, who were significantly older than controls (61.1±16.5 vs. 52.7±20.0; P < 0.001). The outcome analysis of esophageal pathology revealed an independent association between HH, regardless of its size, and erosive reflux esophagitis (25.7% vs. 6.2%; OR = 3.8; P < 0.001) and Barrett's esophagus (3.8% vs. 0.7%; OR = 4.7, P < 0.001). Furthermore, following rigorous age and sex matching, in conjunction with additional multivariable analyses, large HHs were associated with higher rates of benign esophageal strictures (3.6% vs. 0.3%; P < 0.001), Mallory Weiss syndrome (3.6% vs. 2.1%; P = 0.01), and incidents of food impactions (0.9% vs. 0.2%; P = 0.014). In contrast, a lower rate of achalasia was noted among this cohort (0.55% vs. 0%; P = 0.046). Besides reflux-related esophageal disorders, we outlined an association with multiple benign esophageal disorders, particularly in patients with large HHs.

Is a higher frequency of esophageal dilations more effective in treating benign esophageal strictures? Retrospective, multicenter study.

Background and study aims There is still a lack of evidence-based recommendations concerning endoscopic bougienage in benign esophageal strictures. Our study aimed to assess the relevance of the time interval between endoscopic dilation (ED) sessions with regard to endoscopic and clinical response. Patients and methods We performed a retrospective study including patients treated with endoscopic bougienage for a benign esophageal stricture in two German centers. Primary endpoint was the number of ED until freedom from dysphagia was achieved. Secondary endpoints were analyses on reaching a diameter of 15 mm and on achieving clinical freedom from symptoms. Results Between April 2014 and March 2020, bougienage was used as the primary treatment for benign esophageal strictures in 238 patients (194 patients in Center 1; 44 patients in Center 2). Both centers differed in their endoscopic bougienage regime: Center 1 was characterized by a higher frequency of interventions compared to Center 2 (median: 2 days [range 1-28] vs. 10 days [range 1-41]; P <0.001). Clinical response was achieved significantly earlier using the high-frequency regimen in all patients except for those with post-radiogen strictures, who clinically benefited from a low-frequency ED program. Accordingly, patients receiving higher-frequency ED reached a significantly larger post-dilation diameter and considerably larger diameter differences. Conclusions The results of our study demonstrate that a treatment concept consisting of higher-frequency bougienages seems to be more effective in treating most types of esophageal stricture. Radiogenic strictures were the only types of stenoses that benefited from a lower frequency ED program.

Dilation of benign esophageal strictures with balloon/bougie; a single center experience

Objective: Narrowing in the esophagus caused by benign conditions such as peptic injury, surgical anastomosis, radiation therapy, Schatzki rings, esophageal webs, erosive injury and eosinophilic esophagitis are called benign esophageal strictures. In the treatment of benign esophageal stricture, endoscopic dilation with balloon or bougie is the first priority. Method: The study included a total of 96 patients who were diagnosed with a benign stricture at the gastroenterology clinic of our university from May 2009 to October 2023. All patients were symptomatic, and their main complaint was dysphagia. The benign stricture was diagnosed through clinical examination, radiological imaging and endoscopy. Patient data were scanned retrospectively. The dilation method (bougie, balloon), the number of times the procedure was permormed and any potential complications were recorded. Stents were applied to patients who did not provide adequate dilatation. Results: A total of 96 patients were included in the study. 47 (49%) of them were women and 49 (51%) were men. The average age was 48±17 years (the youngest was 18, the oldest was 81). A total of 198 dilation procedures were performed on 96 patients. The average follow-up period was 79±54 (1-179) months. Srictures were divided into 4 groups according to etiology as anastomotic stricture, peptic stricture, caustic stricture and post-radiotherapy stricture. Of the cases with stricture, 76 (79.2%) underwent bougie dilation, 26 (27.1%) underwent balloon dilation, 5 (5.2%) underwent bougie and then balloon dilation, and in 5 (5.2%) cases, metallic stent was placed due to failed dilations. Conclusion: This study shows the effectiveness of bougie and/or balloon dilation in treating most of the patients with benign esophageal strictures, with a low complication rate. It is less invasive, comfortable and cost-effective than the alternative surgical approach.

L APPORT DE L ENDOSCOPIE DIGESTIVE HAUTE INTERVENTIONNELLE DANS LA PRISE EN CHARGE THERAPEUTIQUE DES URGENCES (A PROPOS DE 73 CAS)

The aim of our study is to report the contribution of interventional upper GI endoscopyinthe therapeutic management of emergencies, through a retrospective study, over a period of 3 years about 73 cases. The mean age of our patients was 35.73 years (extremes 2 years and 87 years), and the male sex was the most represented in 53%. The indications in our series were dominated by hematemesis in 24 (32.9%) cases. Endoscopic examination found: PH in 31(42.46%) cases with a predominance of VO, peptic ulcer in 6(8.2%) patients, foreign body in 25(34.2%) patients, tumor lesion in 4(5.5%) patients and benign esophageal stenosis in 13(17.8%) patients, however endoscopic examination was normal in 7(9.6%) patients 61 (84%) patients benefited from endoscopic management. The short-term evolution after endoscopic treatment was favorable in 72 (98.6%) patients.

Assessment of effective doses for fluoroscopy-guided balloon dilatation of benign esophageal strictures in pediatric medicine

Interventional examinations are associated with high levels of patient exposure per examination, which makes it particularly important to monitor individual patient doses and to assess radiation risks. The aim of this study was the assessment of effective doses for fluoroscopy-guided balloon dilatation of benign esophageal strictures, whichwasperformedonpediatricpatientsaged 1 to 2 yearsatthe Departmentof Radiosurgical Methodsof Diagnosis and Treatment of St. Petersburg State Pediatric Medical University. Patient exposure patterns were basedonourowndatacollection. Thecalculationofeffectiveandorgandosesofpatientsnormalizedbythevalue of the dose area product measured during the study was carried out using PCXMC 2.0 software. The conversion coefficients from the dose area product to the effective dose were calculated using tissue weighting coefficients from the ICRP Publications 60 and 103 their values were 10.7 and 11.7 µSv/cGy cm2, respectively. The results of verification of the method indicated that the use of inappropriate conversion coefficients leads to an almost double underestimation of children’s effective doses. Differences in the values of conversion coefficients are significant and are explained by differences in voltage, source to image distance, and irradiation field size. A simplified model of patient exposure was proposed, which is described by a single irradiation field. The assessment of effective doses using multi-field and single-field irradiation model shows comparable results, which allows using the differentiated approach to the assessment of radiation doses of patients.

Comprehensive review of materials, applications, and future innovations in biodegradable esophageal stents.

Esophageal stricture (ES) results from benign and malignant conditions, such as uncontrolled gastroesophageal reflux disease (GERD) and esophageal neoplasms. Upper gastrointestinal endoscopy is the preferred diagnostic approach for ES and its underlying causes. Stent insertion using an endoscope is a prevalent method for alleviating or treating ES. Nevertheless, the widely used self-expandable metal stents (SEMS) and self-expandable plastic stents (SEPS) can result in complications such as migration and restenosis. Furthermore, they necessitate secondary extraction in cases of benign esophageal stricture (BES), rendering them unsatisfactory for clinical requirements. Over the past 3decades, significant attention has been devoted to biodegradable materials, including synthetic polyester polymers and magnesium-based alloys, owing to their exceptional biocompatibility and biodegradability while addressing the challenges associated with recurring procedures after BES resolves. Novel esophageal stents have been developed and are undergoing experimental and clinical trials. Drug-eluting stents (DES) with drug-loading and drug-releasing capabilities are currently a research focal point, offering more efficient and precise ES treatments. Functional innovations have been investigated to optimize stent performance, including unidirectional drug-release and anti-migration features. Emerging manufacturing technologies such as three-dimensional (3D) printing and new biodegradable materials such as hydrogels have also contributed to the innovation of esophageal stents. The ultimate objective of the research and development of these materials is their clinical application in the treatment of ES and other benign conditions and the palliative treatment of malignant esophageal stricture (MES). This review aimed to offer a comprehensive overview of current biodegradable esophageal stent materials and their applications, highlight current research limitations and innovations, and offer insights into future development priorities and directions.