Use of fully covered self-expandable metal stents for benign esophageal disorders in children
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Published on: March 25, 2022
Bettina Lange1, Rainer Kubiak, Lucas M Wessel
11 Department of Pediatric Surgery, Medical Faculty Mannheim, Heidelberg University , University Medical Center Mannheim, Mannheim, Germany .
Insights
Fully covered self-expandable metal stents (SEMSs) show promise for treating benign esophageal conditions in children. While generally safe and effective in selected cases, a standardized approach is needed for pediatric use.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
- Medical Device Technology
Background:
- Limited experience exists regarding the use of fully covered self-expandable metal stents (SEMSs) for benign esophageal disorders in pediatric patients.
- Benign esophageal conditions in children can arise from various causes, including congenital anomalies and iatrogenic injuries.
Purpose of the Study:
- To evaluate the safety and efficacy of fully covered self-expandable metal stents (SEMSs) in treating benign esophageal conditions in children.
- To assess outcomes and complications associated with SEMS placement in a pediatric population.
Main Methods:
- Retrospective study of eleven children (median age 30.5 months) treated with SEMSs for benign esophageal conditions between 2006 and 2014.
- Etiologies included postoperative strictures, recurrent fistulas, anastomotic leaks, and iatrogenic perforations.
- Patients were managed through interdisciplinary cooperation between pediatric surgery and endoscopy.
Main Results:
- Median stent placement duration was 29 days, with some patients receiving multiple stents successively.
- No immediate complications occurred during stent insertion or removal.
- Successful treatment without further intervention was achieved in 55% of patients; 18% required post-removal dilatation.
- 27% of patients did not improve and required surgery. Minor complications (45%) included reflux, migration, and pneumonia.
Conclusions:
- Fully covered self-expandable metal stents (SEMSs) can be safely and effectively used in selected pediatric cases of benign esophageal disorders.
- SEMSs are suitable for emergency procedures or as adjuvant therapy for strictures, leaks, or perforations.
- A standardized management approach for SEMS use in children is essential.
Purpose:
There is a lack of experience with fully covered self-expandable metal stents (SEMSs) for benign esophageal disorders in children.
Patients And Methods:
Eleven children (six boys, five girls) with a median age of 30.5 months (range, 1 month-11 years) who underwent treatment with SEMSs for a benign esophageal condition between February 2006 and January 2014 were recruited to this retrospective study. Etiologies included esophageal atresia with postoperative stricture (n=4), recurrent fistula (n=1), and/or anastomotic leak (n=1), as well as iatrogenic perforation of the esophagus following endoscopy (n=4) or laparoscopic fundoplication (n=1). As part of an interdisciplinary cooperation patients were jointly managed from the Department of Pediatric Surgery and Central Interdisciplinary Endoscopy at our institution.
Results:
Median duration of individual stent placement was 29 days (range, 17-91 days). In 4 cases up to four different SEMSs were placed successively over time. There were no complications noted at stent insertion or removal. At follow-up, 6 patients (55%) were successfully treated without further intervention. Two children each (18%) underwent one single dilatation after stent removal and remained well afterward. Three patients (27%) did not improve following stenting and required definite surgery. Minor stent-related complications were noted in 5 cases (45%), including gastroesophageal reflux (n=2), silent stent migration (n=2), and pneumonia (n=1).
Conclusions:
SEMSs for benign esophageal disorders in children can be used safely and effectively in selected cases, including esophageal anastomotic strictures, esophageal leaks following primary surgery, or perforations postdilatation. An SEMS can be applied either as an emergency procedure or as an adjuvant treatment further to endoscopy or previous surgery. Establishment of a standardized approach in the pediatric population is mandatory.
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