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Postsurgical Perforation of the Esophagus Can Be Treated Using a Fully Covered Stent in Children
Chantal Chauvet1, Arnaud Bonnard, Alexis Mosca
1*Pediatric Gastroenterology Department †Pediatric Surgery Department, Robert-Debré Hospital, Paris, France.
Insights
Fully covered self-expanding metallic stents (SEMS) effectively closed upper digestive leaks in 90% of pediatric patients. While generally safe, stenosis occurred in some cases, requiring further intervention.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- Esophageal and gastric perforations in children often lead to poor outcomes with high morbidity and mortality.
- Traditional surgical and conservative treatments have significant limitations.
Purpose of the Study:
- To evaluate the effectiveness and safety of fully covered self-expanding metallic stents (SEMS) for treating upper digestive leaks in pediatric patients.
- To assess SEMS as an alternative to high-morbidity surgical repairs.
Main Methods:
- Retrospective review of 10 pediatric patients treated with SEMS for esophageal or gastric perforations between January 2011 and January 2015.
- Primary outcome: perforation closure. Secondary outcomes: antibiotic duration, parenteral nutrition duration, adverse events, and hospitalization length.
Main Results:
- Nineteen SEMS were placed in 10 children (median age 5.5 years).
- Perforation closure was achieved in 9 out of 10 patients within a mean of 36 days post-stenting.
- Four out of nine sealed perforations developed stenosis, managed with dilation or surgery.
Conclusions:
- Fully covered SEMS demonstrate benefit in closing pediatric esophageal perforations, potentially avoiding high surgical morbidity.
- Stenosis is a notable complication, particularly after larger perforations, necessitating careful monitoring and management.
Objectives:
Surgery and conservative treatment of esophageal or gastric perforations are both often associated with poor results and carry a high morbidity and mortality rate. The aim of the present study was to evaluate the effectiveness and safety of using fully covered self-expending metallic stents (SEMS) in children with upper digestive leaks.
Methods:
This retrospective study reviewed all children with esophageal or gastric perforation who were treated with placement of an SEMS from January 2011 to January 2015. Closure of the perforation was the primary outcome measured. Secondary outcomes were the duration of antibiotic therapy and parenteral nutrition, adverse events, and length of hospitalization.
Results:
A total of 19 SEMS were placed in 10 patients (median age: 5.5 years; 5 girls) treated for postanastomotic leaks of esophageal atresia (n = 3), esophagogastroplasty (n = 4), resection of esophageal duplication (n = 1) or perforation during Toupet surgical dismantling (n = 1), and gastric rupture after Nissen surgery (n = 1). The perforation closed in 9 out of 10 patients in a mean of 36 days after stenting (range: 13-158 days). All patients received antibiotic therapy for an average of 17.5 days (3-109 days) and parenteral nutrition for 49 days (17-266 days). During a median follow-up of 8.9 months, 4 out of 9 sealed perforations developed stenosis, which was efficiently treated by endoscopic dilations in 2 patients and surgical redo in 2 patients with dilation-resistant stenosis.
Conclusions:
Covered stents appear to be beneficial in closing esophageal perforations in children and can avoid the high morbidity of a surgical repair. Stenosis, however, occurred frequently after larger leakages.
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