Esophageal Strictures In Children Research Articles

Endoscopic therapy of oesophageal strictures in children - a multicentre study.

IntroductionOesophageal strictures are rare in children but may require endoscopic dilation.AimTo gather information on centres performing endoscopic oesophageal dilation in Poland.Material and methodsThe data were obtained from questionnaires concerning the relevant data mailed to 22 paediatric endoscopy centres. Completed questionnaires were received from 11 centres.ResultsIn 2010 the 11 Polish paediatric endoscopy centres performed a total of 10,650 endoscopic procedures. This included 347 oesophageal dilations in 106 paediatric patients aged from 1 month to 18 years. The numbers of patients treated at individual centres ranged from 2 to 40. The indications for oesophageal dilation were as follows: postoperative strictures in 68 children, oesophageal burns in 17 children, postinflammatory strictures in 14 children, achalasia in 4 children, and strictures caused by a foreign body in 3 children. Rigid guidewire dilators were used in the majority of procedures (271), rigid dilators without a guidewire in 32 procedures, and balloon dilators in 45 procedures. A total of 203 procedures were conducted under fluoroscopic guidance, and 144 without the use of fluoroscopy. The number of dilating sessions performed in individual children varied from 1 to 6 and more.ConclusionsOesophageal dilation constituted a minor proportion of all paediatric endoscopic procedures. The majority of children requiring dilation were patients up to 3 years of age with postoperative oesophageal strictures. In the majority of the centres rigid guidewire dilators were used, and in one third of the procedures these dilators were introduced without fluoroscopic guidance.

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.

A prospective controlled study to assess the use of mitomycin C in improving the results of esophageal dilatation in post corrosive esophageal stricture in children

ObjectivesThe aim of this study is to investigate the efficacy of topical application of mitomycin C after dilation in pediatric patients having post corrosive esophageal stricture. MethodsThirty patients with post corrosive esophageal strictures were divided into two groups: 12 patients had repeated esophageal dilation without mitomycin C application, 18 patients had repeated esophageal dilation and topical application of mitomycin C. ResultsThere was a highly significant difference in the improvement of dysphagia grade at the end of follow up in the mitomycin C group (p=0.005). The number of repetition of dilatation ranged from 2 to 6 (median=3) in the 1st group, and 2 to 4 (median=2.5) in the mitomycin C group. There were no adverse effects from the topical application of the mitomycin C. ConclusionsTopical application of mitomycin C after oesophageal dilation can be beneficial in improving dysphagia in patients with post corrosive oesophageal stricture.

Esophageal Strictures in Children

Introduction: To evaluate main aspects of esophageal strictures in children. Materials and Methods:This cross-sectional study was performed on 43 cases of esophageal stenosis ranging from 1 month to 10 years of age who were admitted in Ghaem and Dr. Sheikh Hospitals from 1995 to 2003 in Mashhad, Iran. Results: Most cases were male (56%). The most common cause of esophageal stricture was anastomotic stricture after esophageal atresia surgery (34.9%) followed by strictures due to gastroesophageal reflux (25.6%), chemical burns (11.6%), and congenital a (11.6%). Proximal esophagus was the most common site of stricture (48.8%). Dilatation and operation had been chosen as the treatment of choice for most of our cases (42%). The majority of our patients recovered after receiving the proper treatment (60.5%). Conclusion: Anastomotic stricture after surgical repair of esophageal atresia comprised the most common cause of esophageal stricture. Proximal esophagus was the most common site of stricture. Most of the patients recovered with dilatation, surgery, or a combination of the two.

Peptic Esophageal Stricture in children: A Case report & review of literature

Peptic Esophageal Stricture in children: A Case report & review of literature

Su1764 Traversing Difficult Esophageal Strictures in Children

Su1764 Traversing Difficult Esophageal Strictures in Children

Endoscopic incision plus esophageal stenting for refractory esophageal stricture in children

Endoscopic incision plus esophageal stenting for refractory esophageal stricture in children

The role of endoscopy in the evaluation and management of dysphagia

The role of endoscopy in the evaluation and management of dysphagia

Retrievable Z-Stents for the Treatment of Refractory Corrosive Esophageal Strictures in Children

The use of retrievable esophageal stents represents a new method to avoid multiple dilations for stenosis recurrence. The aim of this study was to evaluate the efficacy of treatment with a retrievable covered Z-stent for corrosive esophageal stenosis in children. A total of 15 children were enrolled in this study. All patients had undergone balloon catheter dilatation (BCD) but without significant symptomatic improvement. A retrievable Z-stent was placed, and the dysphagia score was evaluated. After stent removal, healing was considered to have occurred if the score was 0 to 1 for at least 12 continuous months. Stents were placed in all children without complications and were later removed successfully. Stents remained in situ for 4 to 8 weeks (mean, 7.4 weeks). Dysphagia scores decreased from 3 to 4 to 0 to 1 in all patients while the stent was in place. During the 12-month follow-up period, seven patients remained free from dysphagia, but eight children had recurrent stenosis and required a subsequent BCD to alleviate symptoms from the stricture. Six of them required placement of a second stent. The use of a retrievable Z-stent is an effective method and may become the treatment of choice for corrosive esophageal stenosis in children.

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.

Efficacy and Safety of Endoscopic Management of Esophageal Strictures in Children

Efficacy and Safety of Endoscopic Management of Esophageal Strictures in Children

Treatment of persistent esophageal leaks in children with removable, covered stents

Removable, fully covered, expandable metal esophageal stents are routinely used in adults for both malignant and benign esophageal disease. Several case reports have demonstrated the use of these stents in the management of caustic esophageal strictures in children. Most iatrogenic esophageal perforations and esophageal anastomotic leaks in children may be expected to heal with nonoperative treatment, although, in a small percentage, the leak may persist. We report 3 patients with complicated esophageal perforations refractory to nonoperative therapy who were successfully managed using covered esophageal stents.

Adverse events of upper GI endoscopy

Adverse events of upper GI endoscopy

Esophageal Endoscopic Dilations

Esophageal strictures in children are serious and require specialized care. Peptic stricture is most common in our context, whereas caustic and congenital strictures are rare. The present study reports our experience in esophageal endoscopic dilation while specifying the causes of esophageal strictures as well as their response to endoscopic treatment. This is a case study during a period of 7 years, in which 60 cases of esophageal stricture were treated with endoscopic dilation by Savary-Gilliard bougies. Our patients were divided into 3 groups: group A for peptic strictures (52 patients), group B for caustic strictures (4 patients), and group C for strictures subsequent to esophageal atresia surgery (4 patients). The age of patients was between 10 months and 17 years. Dysphagia was the main symptom and was the major reason for consultation. Two hundred forty-seven dilation sessions were performed, with an average of 4 sessions per patient ranging from 1 to 15 sessions. The maximum score was observed in group B (50%). Expansion was performed under deep sedation. We had 2 esophageal perforations: 1 in group A and 1 in group B. A good response was obtained in group A (70%) and B (50%). The patients in group C still required repeated sessions. Esophagus endoscopic dilation is an effective technique, especially in peptic stricture, with no need of surgery in some cases. In addition, perforation was rare in this group.

Endoscopic balloon dilatation of esophageal strictures in children

Aim of the study To assess the efficacy and safety of endoscopic balloon dilatation of esophageal strictures in children. Material and methods Design: retrospective case series; population: 49 patients under 18 years of age referred to our center for esophageal strictures; treatment: endoscopic balloon dilatation; outcome parameters: residual dysphagia, weight gain, iatrogenic esophageal perforation, assessment of the esophageal lumen by endoscopy or esophagogram. Results The three main etiologies were esophageal atresia (49%; n = 24), corrosive injury (25%; n = 12), and epidermolysis bullosa (14%; n = 7), followed by a heterogeneous group of rarer causes (12%; n = 6). The number of dilatations ranged from 1 to 8 sessions per patient (median ± SEM: 2 ± 0.3). The length of the follow-up period ranged from 20 to 109 months (median ± SEM: 40 ± 4 months). Treatment was successful in 86% of cases ( n = 42). Twelve percent of patients ( n = 6) had a residual stenosis requiring surgery, and a further one still experienced swallowing difficulties requiring enteral nutrition via gastrostomy in spite of the absence of significant residual stricture. Results were less satisfactory in cases of corrosive injury than with other etiologies. Three esophageal perforations were observed (6% of patients; 2% of procedures). All were medically treated. Conclusions Endoscopic balloon dilatation is a simple, safe and efficacious treatment of esophageal strictures in children.

Endoscopic Balloon Dilatation for Esophageal Strictures in Children Younger Than 6 Years: Experience in a Medical Center

Esophageal strictures in children may be caused by congenital anomaly, caustic agent or foreign body ingestion, complication of reflux esophagitis, and after esophageal surgery. Accidental ingestion of alkaline fluid is the most common cause of corrosive esophagitis in children in Taiwan. In this article, we studied 10 pediatric patients who had esophageal strictures and required endoscopic balloon dilatation (EBD) therapy under general anesthesia from January 2003 to June 2009. The median age of the studied children who received their first EBD treatment was 36.2 months (13.4-60.9 months), with a dilator size of 8.0mm (5-12 mm). The interval between injury and initial EBD was 3.0 months (1.3-60.8 months). The treatment duration averaged 16.7 months (3.0-69.3 months), with 13.5 (4-31) instances of EBD therapy per patient. The greater the length of stricture, the more number of times EBD was needed. In these cases, no severe complication was found after the procedure. The result indicated that EBD under general anesthesia was a safe and effective method to resolve the symptom of dysphagia and diet condition. Because of the limited number of study cases, long-term studies are required to further confirm the clinical effect of EBD under general anesthesia.

Custom dynamic stent for esophageal strictures in children

BackgroundEsophageal stenting represents a new strategy to avoid multiple dilations owing to stenosis relapse. Our custom stent improves esophageal motility unlike the widespread self-expandable plastic esophageal stents. The aim of the study was to confirm the efficacy of treatment with silicone custom stents in esophageal stenosis (ES) in pediatric patients. MethodsA silicone stent of 7-, 9-, or 12.7-mm external diameter is built coaxially on a nasogastric tube that guarantees the correct position. The 2 ends are tailored to allow food passage between stent and esophageal wall. All patients received dexamethasone (2 mg/kg per day) for 3 days and ranitidine/proton-pump inhibitors. Study approval was obtained from our ethical board. ResultsFrom 1988 to 2010, 79 patients with ES, mean age 35.4 months (3-125 months), underwent esophageal hydrostatic/Savary dilations and custom-stent placement, left in place for at least 40 days. Stenting was effective in 70 (88.6%) of 79 patients. Fifty percent of the patients with effective treatment received only one dilation for stent placement. Fourteen patients received more stents successfully. There was one stent-related major complication. ConclusionOur custom stent improves treatment in ES. In caustic injuries, ES stenting represents the first option. In postsurgical ES, we stent after at least 5 dilations.

Anesthesia for balloon dilatation of esophageal strictures in children with epidermolysis bullosa dystrophica: from intubation to sedation

Dystrophic epidermolysis bullosa is a rare disease mainly affecting small children. They often have to undergo different surgical procedures, for example balloon dilatation following esophageal strictures to maintain oral intake and prevent malnutrition. So far, no specific treatment is available for patients with any forms of epidermolysis bullosa. However, more and more minimal invasive surgical techniques are used to manage symptoms of the disease, for example endoscopic balloon dilatation for severe esophageal strictures. In this article implications for the anesthetic management of children with dystrophic epidermolysis bullosa are described. General anesthesia and sedation techniques are feasible if specific prerequisites are fulfilled. The team providing anesthesia and endoscopy must be familiar with the nature and disabilities of this disease. Coordinated care of the involved disciplines is crucial for all planned procedures regarding perioperative management.