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[Treatment of esophageal stenosis in children]
Insights
Dilatation is the preferred treatment for pediatric esophageal stenoses, offering a low morbidity and mortality rate. This approach avoids irreversible damage to the alimentary tract, ensuring better patient outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Context:
- Esophageal stenoses (congenital and acquired) pose significant challenges in pediatric patients.
- These conditions negatively impact nutritional status and quality of life.
Purpose:
- To report the authors' experience in treating 77 cases of esophageal stenoses in children.
- To evaluate the efficacy and safety of different treatment modalities, focusing on non-invasive techniques.
Summary:
- The study reviewed 77 pediatric esophageal stenoses (8 congenital, 69 acquired), including sequelae of esophageal atresias, caustic injuries, and peptic strictures.
- Most cases were treated with endoscopic dilatation (forward and retrograde), with surgical repair reserved for specific congenital cases.
- Complications were minimal (mediastinitis, subcutaneous infiltrations), and no mortality was observed.
Impact:
- Dilatation is recommended as the primary treatment for pediatric esophageal stenoses due to its low morbidity and mortality.
- Long-term follow-up is crucial until growth is complete.
- Esophageal coloplasties are discouraged in pediatric patients due to a high complication rate.
Abstract:
Esophageal stenoses, both congenital and acquired, represent a serious problem in childhood due to the deleterious effects, of these anomalies in the patients nutritional state and lifestyle. Choosing the best way to the solution of such problems is of primary importance, paying special attention to the techniques that may not compromise irreversibly the continuity of the alimentary tract. The authors experience on the treatment of 77 esophageal stenoses, 8 of which were congenital and 69 acquire, is reported. Of this group, 24 are sequelae of esophageal atresias, 33 are of caustic origin and 12 of peptic nature. In 3 congenital stenoses with a cartilaginous matrix, surgical repair was undertaken. In the remaining cases forward and retrograde dilatation guided by a thread, through the gastrostomy orifice were performed, in accordance to the length and severity of the stenoses. Duration of the treatment varied broadly, ranging from 3-5 anterograde sessions, in the cases of esophageal atresia sequelae, to several years with an average monthly periodicity of one session in cases of total pharyngoesophageal caustic burn. As for complications, there were three cases of mediastinitis and two of subcutaneous infiltrations at the cervical level that were solved with antibiotics. The authors believe, on the basis of their experience, the absence of mortality and the scarce morbidity that, in the pediatric patients the treatment of choice of esophageal stenoses consists of dilatations on their different modalities. A yearly follow-up must be strictly maintained until the patients have completed their growth. We reject esophageal coloplasties in the pediatric age because of their complications rate.(ABSTRACT TRUNCATED AT 250 WORDS)