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Published on: April 17, 2020
[Evaluation of stents in treating childhood benign esophageal strictures]
K Reinshagen1, G Kähler, B C Manegold
1Kinderchirurgische Klinik, Fakultät für klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany. Konrad.Reinshagen@kch.ma.uni-heidelberg.de
Insights
Esophageal stenting is safe and effective for treating benign esophageal strictures in children. Different stent types offer varying benefits, with plastic stents showing good results but requiring patient compliance, while nitinol stents suit low-compliance cases.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Pediatric Surgery
Background:
- Esophageal strictures in children often require advanced treatment beyond dilatation.
- Esophageal stenting is an established therapy for adults but less studied in pediatric populations.
- Benign esophageal strictures can arise from various causes, including caustic ingestion and post-surgical complications.
Purpose of the Study:
- To evaluate the safety and efficacy of esophageal stenting in pediatric patients with benign esophageal strictures.
- To compare the outcomes of different types of esophageal stents used in children.
- To assess the long-term effectiveness of esophageal stenting in this demographic.
Main Methods:
- A retrospective review of 12 pediatric patients treated with esophageal stents between 1993 and 2005.
- Inclusion criteria: complicated benign esophageal strictures unresponsive to dilatation.
- Stent types included silicon tubi, self-expanding plastic stents, and covered self-expanding nitinol stents, placed endoscopically.
Main Results:
- All stent placements and removals were performed without immediate complications.
- Self-expanding plastic stents achieved successful stricture treatment in 5 out of 6 patients, despite migration in one case.
- Covered nitinol stents showed no migration, with varied outcomes including one requiring resection.
- Esophageal tubi had a higher recurrence rate, with 2 out of 3 patients needing further surgery.
Conclusions:
- Esophageal stenting is a safe and effective modality for benign esophageal strictures in children.
- Self-expanding plastic stents offer good long-term results but necessitate high patient/parental compliance due to migration risk.
- Nitinol stents are suitable for patients with lower compliance, though extraction can be more challenging.
- Esophageal tubi demonstrated lower efficacy, potentially due to a lack of radial expansion, leading to higher recurrence rates.
Background:
Esophageal stenting is a popular of treatment of esophageal strictures in adults. It has also been described for children with benign strictures who did not respond to standard dilatation therapy. The aim of the study was to evaluate weather esophageal stents could be used safely and effectively in the treatment of benign esophageal strictures in children.
Patients:
From 1993 to 2005 stenting therapy was performed in 12 children with complicated esophageal strictures. Etiologies of the strictures were caustic burns in 9 patients, postoperative strictures due to complicated esophageal atresia in 2 patients and iatrogenic esophageal injury in 1 patient.
Method:
Esophageal silicon tubi, covered retrievable expandable nitinol and plastic stents were placed endoscopically. The clinical course and the long term follow up were evaluated retrospectively
Results:
The stents and tubi were placed in all patients without complications and were later removed successfully. 6 patients were treated with a self expanding plastic stent. The plastic stents showed a distinct tendency to migrate but in 5/6 patients esophageal stricture was treated successfully. 3 patients were treated by a covered self expanding nitinol stent. No migration occurred. One patient was asymptomatic after therapy, one required further dilatation therapy and the third had esophageal resection. 3 patients were treated by esophageal tubi. 2 patients required surgery in the follow up, one patient is asymptomatic.
Conclusion:
The use of stenting devices in children to treat benign esophageal strictures is safe and efficient. The self expanding plastic stents had the best long term results but required high compliance of parents and children due to the tendency of stent migration. Self expanding nitinol stents are more traumatic at the extraction procedure and are useful in patients with low compliance. Recurrence of strictures occurred most often after esophageal tubi possibly due to the lack of radial expansion.
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