Stents In Children Research Articles

Double J Ureteral stent removal in children non cystoscopically: A preferred innovation.

Objective: To determine the feasibility of non cystoscopic removal of double J ureteral (DJ) stent using a foley catheter with suture in children in terms of success rate, number of attempts required and complications. Study Design: Cross Sectional study. Setting: Department of Pediatric Surgery, Services Hospital, Lahore. Period: August 2022 to August 2023. Methods: All the children who underwent DJ stent placement for any urological procedure were included if DJ stent was seen in the bladder postoperatively. After informed consent, under sedation and aseptic measures, the foley catheter with suture already passed through its eye, was introduced per urethral after adequate lubrication. The foley was given five to six rotations in clockwise direction for right sided and anti-clockwise for left sided stents respectively and pulled out keeping traction on the suture. In case of three failed attempts, a cystoscope was introduced under general anesthesia and the stent was removed. Successful removal, number of attempts needed, time taken, and post removal complications were noted to determine feasibility of the procedure. Results: Out of twenty patients, 17 patients (85%) underwent successful removal of DJ stent. The failure rate was 15% as three patients required cystoscope assisted removal. In 13 patients (76.5%) DJ stent was removed in first attempt, whereas in 4(23.5%) patients it required two attempts. Mean time taken was 8.83±7.33 minutes. Complications were noted in 2 patients (10%). Conclusion: Removal of DJ stent in children without cystoscope, using a foley catheter with suture is a safe and feasible procedure with a high success rate and should be attempted in selected cases.

Further experience with polydioxanone airway stents in children

AbstractIntroductionThe aims of this study were to update our experience with biodegradable polydioxanone (PDO) airway stents in children, focusing on effectiveness and safety, and to analyze the factors involved in the different outcomes observed.Materials and MethodsRetrospective study of patients managed with PDO stents from 2012 to 2023. Variables collected: demographics, comorbidities, indication, clinical baseline, stent size, location, complications, clinical outcome, and time of follow‐up. Statistical analyses were performed to detect the eventual contribution of variables in the different outcomes observed.ResultsFifty‐four PDO stents were placed in 26 patients (median age, 4 months). All showed severe symptoms of central airway obstruction due to tracheomalacia in nine patients, bronchomalacia five, tracheobronchomalacia 10, and tracheal stenosis two. Stent placement was uneventful in every case: 29 stents in the trachea and 25 in the main bronchi. 53.8% of patients needed successive stenting, and all exhibited comorbidities. Complete clinical resolution was observed in eight cases (30.7%), partial improvement in 13 (50%), unchanged in 4 (15.3%), and worsened in one. Age had a significant positive impact on outcome (6 vs. 3 months; p = 0.024). Additionally, smaller stents were associated with a better outcome (20 vs. 26 mm; p = 0.044). Granulation tissue was the most frequent complication (34.6%). Five patients (19.2%) died due to severe comorbidities, follow‐up was complete in survivors (median, 58 months).ConclusionsPDO stents are safe and effective when dealing with severe tracheobronchial obstruction. Stent‐related granulation tissue continues to be a relevant matter of concern. This issue, together with increased degradation times, deserves further research.

Choanoplasty in children of the first year of life: new opportunities and rehabilitation without stents

Evaluation of the effectiveness of the choanoplasty method using fibrin glue for fixation of flaps without the use of a stent in children of the first year of life with choanal atresia. For the period from 2019 to 2023, a team of authors in the Department of Otorhinolaryngology of the Veltishchev Research Clinical Institute of Pediatrics and Pediatric Surgery operated on 34 patients under the age of one year with a diagnosis of choanal atresia using this choanoplasty technique. The results of this new surgical technique using fibrin glue are presented. Endoscopy of the nasal cavity and choanal area in all 34 patients during follow-up (from 1 to 2 years) showed no signs of restenosis. The proposed method of choanoplasty without the use of stents with fixation of mucosal flaps with fibrin glue has proven itself well and can be used in children at any age, can be one of the ways to solve the problem of restenosis and seems to us to be the method of choice in the treatment of choanal atresia.

Efficacy and Safety of External Versus Internal Stenting in Children with Open Pyeloplasty for Primary Ureteropelvic Junction Obstruction. A Single Centre Experience

Background: Ureteropelvic junction obstruction (UPJO), a condition, stops urine from freely passing from the renal pelvis to the ureter. It is a common urological condition, with a male to female ratio of 2:1 and an incidence of 1 in 500 (1). UPJ obstruction may be caused by inherited and acquired diseases. The majority of cases are congenital due to intrinsic or extrinsic causes (2). Objective: To determine the efficacy and safety of external versus internal stenting in children with primary Ureteropelvic junction obstruction. Material and Methods: At the Institute of Kidney Diseases in Hayatabad, Peshawar, Pakistan, a randomized controlled study was carried out from January 2021 to December 2021. Patients were split into two groups based on the kind of stent that was used. All patients with DJ stents were placed in Group A, and patients with PU stents (5–6 Fr feeding tubes) that passed through the kidney parenchyma on their way from the ureteropelvic junction to the skin belonged in Group B. Results: 80 people in total (55 men and 25 women) were enrolled in the study. In groups A and B, the mean ages at surgery were 3.4 and 3.9 years respectively. Table 1 displays the patient's demographics and surgical factors. The two groups' mean operating times (124 ±3.4 for group A and 130 ± 3.1 for group B) were comparable. The DJS group's stent duration ranged from 3 to 4 weeks, with a mean of 27 days, while the PU group's ranged from 1 to 2 weeks, with a mean of 13 days. In DJS and PU stent, the median hospital stay was 1.3 and 2.8 days, respectively. Practical Implication: The surgeon must compare the inconvenience of a second anaesthesia, the cost, and the DJ stent's potential for complications against the longer hospital stay that comes with PU stenting and advise parents accordingly. Conclusion: According to our findings, the complication rates and mean operating time for both types of stents were comparable. Even though the DJS stent requires less recovery time than the PU stent, its removal still required a second anaesthesia Keywords: External Versus, surgical factors, ureteropelvic junction obstruction, urine, Congenital

Use of Temporary Double-J Stent Placement for Children With Congenital Hydronephrosis: A Long-Term Single-Center Cohort Study

ObjectiveTo evaluate the utilization of double-J stents in children with congenital hydronephrosis in order to avoid or postpone more invasive surgical intervention. Numerous studies have demonstrated that congenital hydronephrosis caused by ureteropelvic junction obstruction (UPJO) or primary obstructive megaureter (POM) may require a surgical correction in up to 20% of cases. MethodsAll infants with severe hydronephrosis and/or an obstructive pattern on renal scintigraphy that received double-J stent placement between 2010 to 2015 in our center were analyzed. Children were followed regularly with ultrasound and received antibiotic metaphylaxis. Urinary tract infection (UTI) and double-J dislocation were defined as complications. Treatment success was defined as avoidance of surgery and reduction of hydronephrosis to grade 1 or 0 during the observation period. Results29 children were included, in these, 34 (23 UPJO, 7 POM, 4 UPJO and POM) treatment attempts were performed. Stent implantation failed in six cases, resulting in 28 double-J stent treatments, of which 19 (69%) were successful within the follow-up period of 20 to 104 months. The most common complications were febrile UTI in 6 of29 cases and double-J dislocation in 3 of 29 cases. ConclusionDuring the observation period, the success rate of temporary double-J in urodynamically relevant obstruction was relatively high. However, urinary tract infections and a complex disease course due to renal stent dislocation, as well as the need for repeated anesthesia and radiation exposure, should be taken into account. Hence, we do not recommend double-J stents placement in all children with congenital hydronephrosis; it may be useful in selected cases.

Early outcomes of the treatment of aortic coarctation with BeGraft aortic stent in children and young adults.

We report our experience and early outcomes of using the BeGraft aortic stent in children, adolescents, and young adults. BeGraft aortic stent (Bentley InnoMed, Hechingen, Germany) requires a smaller long sheath compared to other covered stents, and it has a low profile and adequate radial power. With these features, it can overcome some limitations in the treatment of coarctation, especially in children. This is a single centre retrospective analysis of 11 implanted BeGraft aortic stents in coarctation of the aorta between July 2020 and November 2021. The eleven stents were successfully implanted in 11 patients (10 males). The median age of the patients was 13.7 years (interquartile range 12-16 years), and the median weight was 43 kg (interquartile range 35-62 kg). In five patients, after the stents were opened completely by the first balloon, they were exchanged with a Z-MED II™ balloon, 1-3 mm larger in diameter, and the stents were redilated. The median catheter-derived systolic peak-to-peak pressure gradient was 23 mm Hg (interquartile range 16-37 mmHg) before the procedure and 3 mm Hg (interquartile range 1-5 mm Hg) after the procedure. Except for the partial femoral artery thrombosis in two patients, no other procedural complications were observed in our study. The median follow-up duration was 5 months (interquartile range 2-12 months). During follow-up, only one patient (9%) had stent narrowing that required dilation. Our initial results and short-term follow-up showed that the BeGraft aortic stent implantation and redilation can be performed effectively, safely, and successfully in the treatment of coarctation of the aorta.

Initial status and 3-month results relating to the use of biodegradable nitride iron stents in children and the evaluation of right ventricular function.

BackgroundPulmonary artery stenosis is often associated with congenital heart disease. The aim of the study was to evaluate the efficacy and safety of stenting for branch pulmonary artery stenosis using a biodegradable nitride iron stent (IBS® Angel™) and right ventricular systolic and diastolic function.MethodsFrom July 2021 to February 2022, a total of 11 cases (ages ranged from 36 to 86 months old) were included in this pre and post-intervention, prospective, cohort and preclinical study. All cases underwent transthoracic echocardiographic (TTE), chest radiography, along with computed tomography (256-slice scanner, multiple-detector) and right heart catheterization. Different types of biodegradable nitride iron stents were implanted. TTE was performed serially 1 day, 1 month and 3 months after the procedure to evaluate the rate of restenosis and right ventricular function.ResultsStenting was successful in 11 patients. There were no major adverse cardiovascular events related to the device or to the procedure. Blood perfusion in the branch pulmonary artery was improved immediately. At follow-up, there was no significant restenosis that required re-intervention. None of the patients suffered from in-stent thrombosis, vascular embolism, stent displacement or heart failure. Compared with normal values, there were statistical with regards to FAC, E/A and E′/A′. Furthermore, we found that TAPSE correlated significantly with pulsed Doppler S wave (p = 0.008) and left ventricular ejection fraction (p < 0.01). The early trans-tricuspid inflow velocities E/E′ (tissue doppler at the lateral tricuspid annulus) correlated significantly with E′/A′ (p = 0.009). FAC and E′/A′ were statistically different from those prior to stenting (p = 0.041 and p = 0.035) when tested one month postoperatively. At three months postoperatively, only E/A showed a statistical difference (p = 0.015).ConclusionOur analysis suggests that biodegradable nitride iron stents are feasible, safe, and effective in children. Some small improvements were observed in right ventricular systolic and diastolic function after successful transcatheter intervention, although change was not statistically significant due to the small sample number. (A clinical Trial to Evaluate the Safety and Efficacy of IBS Angel in Patients With Pulmonary Artery Stenosis (IRIS); NCT04973540).

Safety and efficacy of aortic coarctation stenting in children and adolescents

Percutaneous aortic coarctation treatment with primary stent implantation is the first choice in adult patients. However, current guidelines do not suggest a lower weight limit to perform this procedure safely.The aim of this study was to retrospectively analyze the safety and the mid-term outcome of aortic coarctation stenting in pediatric age at different patients’ weights.We enrolled 47 patients, 8 of them weighting lower than 25 kg, 10 with a weight between 25 and 30 kg and 29 patients with a weight >30 kg.Covered CP stent was used in 32 patients (68.1%), bare CP stent in 6 (12.8%), Andrastent XL in 8 (17.0%) and Palmaz Genesis in one case (2.1%). The balloon mean diameter was 13.8 ± 2.4 mm, range 10–18 mm. The procedure was effective in all patients. The aortic gradient dropped from 28.0 ± 7.8 mmHg to 2.2 ± 2.0 mmHg (p < 0.0001). Hemostasis was achieved by a surgical cut-down in 20 (42.5%) patients, manual compression in 2 (4.3%) or by vascular closure devices (VCDs) in 25 (53.2%) patients. There was no difference in terms of efficacy, safety and complication rate among the three weight-based groups. We found a trend toward higher incidence of vascular complications following hemostasis with VCDs (4/24, 16.7%) vs surgical cut-down (1/21; 4.8%)In conclusion, aortic coarctation stenting is a safe procedure in patients weighing less than 30 kg. Surgical arterial cut-down can minimize the risk of vascular injury by reducing the stress on the arterial wall in smaller patients, or in case, a large sheath is needed.

Endoluminal Silicone-Covered Stenting in Children: Novel Applications and Lessons Learned.

Silicone-covered endoluminal stents have been applied to various hollow visceral disorders in adult patients with varying success. Efficacy of retrievable endoluminal stenting in children is less well-established. The purpose of this study was to evaluate our experience with evolving applications of endoluminal silicone-covered stenting in children. Eight children 19 years and younger having silicone-covered stent placement for various indications at a single institution (2014-2021) were reviewed retrospectively. Eight patients received a total of 26 silicone-covered stents. Four stent placements (15.4%) were associated with a direct adverse event. To resolve the endoluminal disorder, four patients received multiple stents or further intervention. When evaluating novel applications, clinical benefit was noted for one patient with vaginal atresia, and another after ileal pouch anal anastomosis disruption. This experience highlights the broad and innovative applications for endoluminal silicone-covered natural orifice stenting in children. Acute processes respond well and rapidly to stenting, although chronic, established fistula may require additional manipulations or surgery.

Complications and Management of Retained Double-J Stents in Children During the Coronavirus Disease-2019 Pandemic.

Double-J (DJ) stents were commonly used for internal drainage after major reconstructive procedures or in cases of obstruction and ureteral injuries. They should be removed or changed within the stipulated time; otherwise, they can lead to various complications such as stent occlusion, migration, breakage, encrustation, stone formation at either end of the stent, and entanglement of the two stents if bilateral stenting was done. The present study focuses on the complications and the management due to delay in the removal of the DJ stents due to the coronavirus disease-2019 pandemic. This is a cross-sectional study over a period of 9 months. Children <12 years were included in the study. The patients' demographic data, indication for DJ stenting, time gap between DJ stenting and removal, complication with delay in DJ stent removal, and its management were recorded. Indwelling duration for >4 months was considered a delay in removal. All patients were followed up for 3 months. A total of 10 patients were included in the study. Encrustation, proximal migration, distal migration, knotting of the stent, and entanglement of the bilateral stents in the bladder were observed. These complications were managed by various endourological procedures such as ureteroscopy, percutaneous nephroscopic, and cystoscopic removal. During follow-up, all patients were symptom-free. Prolonged indwelling stents can cause various complications. Endourological procedures are an essential armamentarium for a pediatric surgeon to manage these complications. Proper patient counseling regarding indwelling stents and maintaining stent registry and sending automatic messages and e-mails to patients may prevent these complications.

THE OUTCOME OF PALLIATIVE STENTING IN CYANOTIC CONGENITAL HEART DISEASES

Objective: To determine the outcome of palliative stenting in children with cyanotic congenital heart diseases. Methodology: From February 2018 to October 2020, the Department of Paediatric Cardiology at Lady Reading Hospital in Peshawar conducted a cross-sectional study on patients who underwent right ventricular outflow tract blocked Blalock Taussig shunt stenting or patent ductus arteriosus stenting for cyanotic congenital heart disease. The patients' information was gathered using a pre-formatted proforma. Pre- and post-procedure oxygen satu­rations were recorded for 48 hours. The favorable outcome was defined as an increase in oxygen saturation of at least 15%. Results: The mean age of the sample (n=49) was 20±29 months. The etiology was Pulmonary Atresia (PA) with Patent ductus arteriosus (PDA) in 23 patients, followed by blocked Blalock Taussig Shunt (BT-Shunt) in 9 patients. The number of patients who underwent PDA stenting was 32, 9 patients had stenting of blocked BT-Shunt and 8 patients had RVOT stenting. The mean pre-intervention oxygen saturation was 43% ±8.9% and the mean post-in­tervention oxygen saturation was 81% ±5.3%. The number of patients who died was 2, one patient for RVOT stenting died on the table due to cyanotic spell while other post-PDA stenting died because of stent thrombosis. Conclusion: RVOT, Patent Ductus arteriosus, and blocked Blalock Taussig shunt stenting was found effective in increasing oxygen saturation in children with cyanotic PDA.

Heart function and remodeling after successful stenting of coarctation of aorta in children

Background: There are not enough studies investigating the results of stent implantation for Coarctation of the Aorta (COA) in the pediatric age group. Objective: This investigation evaluated the heart function and remodeling after successful COA stenting in children. Materials and method: The study was performed from April 2017 till April 2020 on patients with COA (&lt;18 years old) referring to Namazi, Faghihi and Kowsar hospital, tertiary centers from 2010 till 2017. Demographic data, clinical examination results and echocardiographic parameters were reported. All statistical analyses were performed with the SPSS version 22. Results: Fourty-two children were enrolled in this study. Mean age at the time of stenting was 10.44 ± 3.93, and mean follow-up was 3.57 ± 3.40 years (1-6 years). 24 patients (77.8%) were male. Measurement of thoracic aorta diameters revealed that mean transverse arch, isthmus and distal arch diameter with its z-scores were 1.40 ± 0.43 (Z score = -1.50 ± 1.33), 1.17 ± 0.28 (Z score =-0.72 ± 1.43) and 1.21 ± 0.42 (Z score = -0.94 ± 3.46). Mean systolic blood pressure at the follow-up time was 122.5 ± 17.70 mmHg, and mean diastolic blood pressure was 81.25 ± 9.57. Significant correlation existed between IVSd value and transverse arch diameter (P=0.023, r=0.564), and also distal arch diameter (P=0.039, r=0.521). There was also a significant correlation between LVIDd and measured transverse (P=0.007, r=0.648) and distal arch diameter (P=0.034, r=0.521). Instead, the correlation between E/A value and IVSs (P=0.023) and IVSs Z score (P=0.044, r=0.480) was significant. There was a significant correlation between LVPWd parameter and Doppler measurement of the gradient at the stent site (P=0.024, r=0.621) measured at the time of follow-up. Conclusion: Based on the results, endovascular stenting to treat CoA appears to be a safe and efficient method. LV hypertrophy and diastolic dysfunction did not regressin a significant number of patients after successful stenting. Keywords: aortic coarctation; child; heart; stents.

Analyzing the Safety and Efficacy of Flow-Diverting Stents in Pediatric Aneurysms: A Systematic Review.

Ruptured intracranial aneurysms cause 50% of spontaneous subarachnoid hemorrhages in children, resulting in up to 65% mortality when left untreated. Although flow-diverting stents are especially suited to treat the fusiform and giant aneurysms more commonly found in children, the US Food and Drug Administration (FDA) has only approved their use in patients ≥22 years of age. Our objective was to assess the safety of flow-diverting stents in the treatment of pediatric patients with aneurysms through a systematic literature review using the PRISMA criteria. We used PubMed, Embase, and Web of Science to identify all published cases of pediatric aneurysms treated or retreated using flow-diverting stents from 2007 through 2019. Two independent researchers developed a consensus regarding the inclusion of all articles. Patient data were extracted from the identified articles and used to calculate the incidence rate of complications. From 1396 journal articles identified, 24 articles contained data on 37 pediatric patients that met the inclusion criteria. Of these 37 patients, 8 (21.6%) had a complication by last follow-up (death: 2; residual aneurysm: 2; parent artery occlusion: 4). This resulted in an incidence rate of 0.018 complications per patient at-risk month (95% CI 0.008-0.035). These data suggest that the use of flow-diverting stents for treatment of aneurysms in children may be safe and that FDA approval for this use should be evaluated. Although this analysis is comprised of case reports and case series, it represents the best attempt thus far to quantify the risk of using flow-diverting stents in children.

Cheatham-Platinum 10-zig stents for transcatheter treatment of congenital heart diseases: A new tool to widen the spectrum of treatable conditions

ObjectivesTo report our experience using the 10-zig C-P stents in children and adults with congenital heart disease. BackgroundThe use of stents in congenital heart disease has become widespread since the 1990s and a large range of stents has been designed for a variety of indications. In many situations there is a need for stents that can be dilated to large diameters without excessive shortening. Cheatham-Platinum (10-zig C-P) (NuMED, Hopkinton, NY, USA.) stents may fulfil this requirement. MethodsBetween January 2015 and January 2020, 17 patients with congenital heart disease were treated using a 10-zig C-P stent at our center. (6 Females 13 males; (median age 33 years (range 10–69 years); median weight 85 kgs (range 25–119 kg). Indications for use of the 10-zig stents were right ventricular outflow tract (RVOT) interventions in 8 subjects and aortic coarctation in 9 patients. Results1) Right ventricular outflow tract stenting. Ten right ventricular outflow tract stents (2 also had implantation of transcatheter valves in the same procedure) were implanted in 8 patients. All the RVOT interventions were in preparation for a transcatheter pulmonary valve. Median fluoroscopy and procedure times were 41 min (range 31–131 min) and 164 min (range 152–361 min), respectively. One patient had distal perforation of a pulmonary artery due to guide-wire injury and required blood products. Two subjects showed stent fracture during follow-up needing further stent implantation. 2) Aortic Coarctation. Nine stents were implanted in 9 patients. The median fluoroscopy and procedure times were 36 min (range 11–75 min) and 164 min (range 95–225 min), respectively. The median peak systolic gradient reduced from 33 mmHg (range 15–60 mmHg) to 3 mmHg (range 0–4 mmHg) (p < 0.001). ConclusionsOur experience shows that the 10-zig Cheatham-Platinum stents can be used successfully and safely in congenital heart diseases.

Pediatric canalicular laceration repair using the Mini Monoka versus Masterka monocanalicular stent.

One of the most important disadvantages of using Mini Monoka stents in pediatric canalicular laceration repair is premature stent loss. In this study, we aimed to compare clinical outcomes between the use of Mini Monoka and Masterka monocanalicular stents in children and discuss the potential causes of premature stent loss. The medical records of 36 patients who underwent surgical repair of canalicular lacerations were retrospectively reviewed. Children aged <18 years who underwent canalicular laceration repair with either Mini Monoka or Masterka and had at least 6 months of follow-up after stent removal were included in the study. The patients' demographics, mechanism of injury, type of stent used, premature stent loss, and success rate were analyzed. Success was defined as stent removal without subsequent epiphora and premature stent loss. Twenty-seven children fulfilled our study criteria, and their data were included in the analyses. Mini Monoka was used in 14 patients (51.9%), whereas Masterka was used in 13 patients (48.1%). The preoperative clinical features, including age, sex, and mechanism of injury, were similar between the two groups. The mean age was 8.3 ± 5.5 years in the Mini Monoka group and 7.8 ± 5.9 years in the Masterka group (p=0.61). Three patients in the Mini Monoka group (21.4%) underwent reoperation due to premature stent loss. No premature stent loss was observed in the Masterka group. As a result, the rate of success was 78.6% in the Mini Monoka group, whereas it was 100% in the Masterka group (p=0.22). Even though the two groups did not show any statistically significant difference in success rate, we did not observe any premature stent loss in the Masterka group. Further studies with larger and randomized series are warranted to elaborate on these findings.

The Use of Stents in Children with Nasolacrimal Duct Obstruction Requiring Surgical Intervention: A Systematic Review.

Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. It is managed conservatively in the first year of life, after which surgical treatment is classically based on a stepwise paradigm of probing, intubation, and dacryocystorhinostomy. This systematic review aims to present the current role of intubation in the management of children with NLDO requiring surgical intervention. A search for English-language articles from the electronic databases PubMed, SCOPUS, and the COCHRANE library was conducted over a period of five months in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. The following keywords were used to aid retrieval: stents, children, lacrimal intubation, endoscopic dacryocystorhinostomy, external dacryocystorhinostomy, NLDO, dacryocystitis, congenital, acquired. The primary outcome was defined as the success of the intervention, determined by resolution of symptoms and patency of the lacrimal anatomy confirmed by the fluorescein dye disappearance test or syringing. Secondary outcomes included the presence of complications. A total of 144 articles were identified; of these, 35 fulfilled the study criteria. The majority of the included studies involved lacrimal intubation alone, followed by intubation as an adjunctive procedure to balloon dacryoplasty and dacryocystorhinostomy. The overall success rate of these procedures ranged from 41.1% to 100%. Post-operative complications were reported in 65.7% of the included studies. Lacrimal intubation was most commonly performed as a primary procedure in children with NLDO, with high success rates. The main complication was stent dislodgement. There is lack of evidence regarding the benefit of intubation over probing as primary treatment of congenital NLDO. In the absence of high-quality evidence, the decision of whether to perform lacrimal intubation in children with NLDO requiring surgical intervention depends on clinical judgement and other low-level evidence, such as observational non-randomised trials.

Self-expanding esophageal stents for the management of benign refractory esophageal strictures in children: A systematic review and review of outcomes at a single center

BackgroundThis study aimed to evaluate our outcomes and complication rate following placement of self-expanding esophageal stents in children for the management of refractory esophageal strictures and comparing these to the existing literature. MethodsOutcomes following placement of stents in consecutive patients under 18 years at a single center from 2003 to 2018 were reviewed. A PRISMA-guided systematic review was conducted identifying studies with 5 or more children evaluating self-expanding stents published from 1975 to 2018. Endpoints for both the retrospective and systematic reviews were the requirement for further intervention and stent-associated complications. Results25 patients received 65 stents. There were 12 caustic injury-related strictures (48%), 9 anastomotic strictures (36%), and 4 esophagitis-related strictures (16%). Four patients were lost to follow-up. 19/21 patients (90%) required further intervention, and 8/21 (38%) had esophageal replacement. Nine studies, all case series, were included in the systematic review. 97 patients received 160 stents for esophageal strictures and/or perforation. 36 out of 69 patients (52%) with strictures required no further treatment post-stenting, and 22/29 (76%) of esophageal perforations closed with stenting. ConclusionsEsophageal stents may have a role as a bridge to definitive surgery and for the management of esophageal leaks, but complete stricture resolution post-stenting is unlikely. Type of StudyTreatment Study (Case Series with no Comparison Group) Level of EvidenceLevel IV

Double J stent removal in paediatric patients by Vellore Catheter Snare technique: a randomised control trial

Double J (DJ) stents placed at the end of paediatric urological procedures require another cystoscopy under general anaesthesia for removal. The second author developed a reproducible technique for snaring the DJ stent using an infant feeding tube (6-Fr or 8-Fr) and a 3-0 polypropylene suture per urethra. Having demonstrated the proof of concept, ethical clearance was obtained for an institutional randomised controlled trial. The aim of the study was (1) to describe the Vellore Catheter Snare (VeCS) technique for DJ stent removal, (2) to study the efficacy of the technique and (3) to compare the costs of VeCS technique with cystoscopy on an intention-to-treat basis. The study design was that of a randomised control trial with parallel groups as a non-inferiority study. Forty children with unilateral indwelling DJ stents were enrolled from January to August 2018. They were randomised by unequal allocation (1:3) to cystoscopic and VeCS technique removal arms. The VeCS technique and cystoscopy were successful in 86.67% (26/30) and in 100% (10/10) cases, respectively, with no statistically significant difference in the outcome (p=0.223). The average cost for cystoscopic removal of the stent was INR 14,579and was INR 5636.5for the VeCS technique (on an intention-to-treat basis). While per-urethral catheterisation is an outpatient/ward procedure in children, cystoscopy is not. Other techniques such as extraction strings and magnetic stents with their extraction device were found to have certain disadvantages. The VeCS technique, using common disposables, circumvented the need for inpatient admission, disinfected equipment usage and operation theatre time in 87% children, thereby reducing the costs incurred by the patient. The VeCStechnique for DJ stent removal is a practical low-cost safe alternative to cystoscopic removal of DJ stents in children. Although the technique has a high success rate, it still needs the backup option of cystoscopy under general anaesthesia.

Image quality and radiation dose of ECG-triggered High-Pitch Dual-Source cardiac computed tomography angiography in children for the evaluation of central vascular stents

Assess image quality and radiation dose of ECG-triggered High-Pitch Dual-Source CTA for the evaluation central vascular stents in children. We included all children ≤ 21years old with one or more central vascular stents and available prospective ECG-triggered High-Pitch Dual-Source CTA performed at our institution between January 2015 and August 2017. Demographic and scanner information was retrieved. Two board-certified pediatric radiologists blinded to the clinical data, independently reviewed and scored each case using a four-point quality score. Scores 1, 2 and 3 were considered of diagnostic image quality. Inter-observer agreement and non-parametric test were used. 18 patients (10 girls, 8 boys) with a mean age of 9.47 ± 7.38years (mean ± SD) met inclusion criteria. Thirty-two central vascular stents were evaluated. Mean quality score was 2.07 ± 0.94 with 12.5% (4/32) of the cases classified as unevaluable. Interobserver agreement was excellent (k = 0.86). There is no significant difference between quality score and stent location (p = 0.07). There is a significant difference with stent material as all non-diagnostic scores were only seen in covered stents made of platinum-iridium (p < 0.001). There was no association between image quality and age, height, weight, BSA, heart rate, radiation dose or stent lumen size (p > 0.05). ECG-triggered high-pitch spiral DS-CTA offers appropriate image quality for assessment of central vascular stents in children.

First-in-man pulmonary artery stenting in children using the Bentley® BeGrow™ stent system for newborns and infants

BackgroundStent implantation into growing vessels is a common treatment option in infants and children with congenital heart disease (CHD) and corresponding vessel lesions. After stent implantation in small children, repetitive stent redilations are frequently necessary to accommodate for somatic growth. Until now, all available stents have limited final expansion diameters. Material and resultsThe new Bentley BeGrow™ stent system for newborns and infants is a L605 cobalt‑chromium, pre-mounted, balloon expandable stent, which is compatible with a 4 French sheath and 0.014 inch guide wire thus allowing implantation in small vessels (4–6 mm). It offers a new, unique stent design that allows post-dilation steps up to Ø11.5 mm. While re-dilating up to Ø11.5 mm this new stent maintains radial force and shows uniform expansion with only minimal foreshortening. Predetermined breaking points allow the stent struts to break in a controlled manner when exceeding a diameter of 11.5 mm. Residual radial force maintains even after stent opening due to spiral arrangement of the predetermined breaking points. The 2 first-in-man pulmonary artery stent implantations in a newborn with univentricular circulation and a toddler with biventricular circulation are reported as part of the currently performed licencing trial (ClinicalTrials.govNCT03287024). ConclusionThe low-profile BeGrow™ stent system offers new treatment options for transcatheter stent implantations in newborns and infants. In our first experience, it can be effectively implanted. Longer follow-up will evaluate multiple, stepwise redilations and controlled stent strut breakage, which have the potential to accommodate for somatic vessel growth and/or subsequent implantation of larger stents.