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[ESOPHAGEAL STENOSIS IN CHILDREN: MEDICAL TREATMENT EXPERIENCE]
Insights
Esophageal stenosis treatment using Savary-Gilliard bougies showed good results in 72.4% of pediatric patients. The number of dilatation sessions required was directly related to the stenosis cause, with caustic agents needing the most interventions.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Surgery
Background:
- Esophageal stenosis in children can result from various causes, including caustic ingestion, gastroesophageal reflux (GER), and post-surgical complications.
- Effective management of pediatric esophageal stenosis is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of esophageal dilatation using Savary-Gilliard bougies in pediatric patients with esophageal stenosis.
- To determine the relationship between the cause of stenosis and the number of dilatation sessions required.
- To analyze the complication rates and treatment outcomes.
Main Methods:
- A retrospective review of 58 pediatric patients (2 months to 15 years) treated for esophageal stenosis between 1992 and 1998.
- Patients were classified into three groups based on the cause of stenosis: caustic agents, GER, and other causes.
- Data on dilatation sessions, response to treatment, and complications were collected and analyzed.
Main Results:
- The number of dilatation sessions was directly correlated with the cause of stenosis, with caustic agents requiring the most sessions.
- A good treatment response was observed in 72.4% of patients, with a mild response in 15.5% and therapeutic failure in 12.1%.
- The overall complication rate was 10.3% per patient, with major complications including perforation and fistulae, though most resolved.
Conclusions:
- Esophageal dilatation with Savary-Gilliard bougies is a secure and efficient treatment for pediatric esophageal stenosis of diverse etiologies.
- Treatment outcomes and the number of required sessions are influenced by the underlying cause of the stenosis.
- Careful monitoring for complications is essential during and after the dilatation procedure.
Abstract:
We present a retrospective evaluation of our experience in the period that goes from January 1992 to December 1998, clinical records of 58 patients ages from 2 months old to 15 years, male and female, who were treated at the GI service of Instituto de Salud del Ni o, were reviewed. All of them had esophageal stenosis and were included in the Esophageal Dilatation Program with Savary-Gilliard bougies. The causes of Esophageal Stenosis in the study were: Caustic agents 37.9%, gastro esophageal reflux (GER) 20.7%, surgery sequela 19.0%, related to esophageal esclerotherapy 12.1%, foreign body itself or maneuvers to retrieve them 8.6%, stomach adenocarcinoma invading the esophagus. Patients were classified in three groups: Group 1: stenosis due to caustic agents Group 2: stenosis due to GER Group 3: The remaining causes mentioned above., In each the following was calculated: the arithmetical media, the range of dilatations sessions and the total number of them. The higher figures took place in group 1. So we conclude that the number of sessions is directly related with the cause of the stenosis, requiring more number of dilatations to get a better response. Finally the response to treatment is evaluated considering a good response in 72.4%. A mild response in 15.5% and therapeutic failure in 12.1% of patients. The rate of complications was 10.3 per patient and 1.1 in relation to the total number of dilatation sessions. The main complications were: gastric perforation, duodenal perforation, pneumomediastinum, esophago-tracheal fistulae andi pseudodiverticulum formation, with resolution as seen in posterior controls. These complications occured after the proceeding took place. The treatment was installed according to each case. The patients with duodenal perforation died. We conclude that esophageal dilatations in infants with esophageal stenosis, of different ethiology, are secure and efficient.