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Endoscopic-guided platelet-rich plasma for refractory oesophageal strictures in children: A single-arm cohort study
Ileana González-Natale1,2, Daysmar Salazar1, Maylin Davila3
1Departament of Pediatric Gastroenterology, Hospital de Niños José Manuel De Los Ríos, Caracas, Venezuela.
Insights
Platelet-rich plasma (PRP) offers a safe and effective treatment for refractory caustic oesophageal strictures (COS) in children. This study shows significant improvement in swallowing and weight gain after endoscopic PRP intralesional administration.
Area of Science:
- Pediatric Gastroenterology
- Regenerative Medicine
- Endoscopic Procedures
Background:
- Caustic ingestion can lead to refractory caustic oesophageal strictures (COS) in children, posing significant risks.
- Current treatments like dilations, intralesional substances, and stents have variable efficacy and potential adverse events.
- Platelet-rich plasma (PRP) shows promise in tissue repair and healing across various medical fields.
Purpose of the Study:
- To evaluate the practicability, efficacy, and safety of endoscopic-guided intralesional platelet-rich plasma (PRP) administration for refractory caustic oesophageal strictures (COS) in children.
- To present the initial prospective findings from Venezuela on this novel therapeutic approach.
Main Methods:
- The study included pediatric patients diagnosed with refractory COS, with a history of 7 months to 3 years post-ingestion.
- Patients had previously undergone treatments including steroids, Mitomycin C, or stent placement.
- Endoscopic-guided intralesional PRP administration was performed on eligible children.
Main Results:
- Fifteen out of sixteen (93.8%) pediatric patients experienced improved swallowing and increased body weight after a single PRP session.
- Only 4 out of 16 patients required a second PRP administration.
- A 6-month follow-up revealed no dysphagia in 15 out of 15 patients, with no reported adverse events related to PRP or dilation.
Conclusions:
- Endoscopic-guided intralesional PRP administration is a safe and effective alternative treatment for refractory caustic oesophageal strictures (COS) in pediatric patients.
- The procedure demonstrated high efficacy in improving symptoms and patient outcomes.
- This approach offers a promising new option for managing complex pediatric esophageal conditions.
Objectives:
Oesophageal stenosis is a serious sequel of caustic ingestion, especially refractory caustic oesophageal strictures (COS) with a high risk of adverse events and variable response to treatments such as dilations, infiltration of substances and stent placement. Platelet-rich plasma (PRP) has been used in various pathologies that require a process of repair and healing of tissues at the skin, mucosa and joints. We aimed to describe the experience managing refractory COS in children with endoscopic-guided PRP intralesional administration, in terms of practicability of the procedure, efficacy and safety in the first prospective series in Venezuela.
Methods:
Children with refractory COS, with a length of evolution between 7 months to 3 years, and previous treatment attempts (steroids, Mitomycin C or stent placement), underwent endoscopic-guided PRP intralesional administration.
Results:
Sixteen patients were included. After only one PRP administration session, 15/16 (93.8%) patients had improvement in dysphagia, in solid food tolerance and an increase in body weight. Only 4/16 (p < 0.001) requested a second infiltration session. One patient was withdrawn from the follow-up by the tutor. During the first 6-month follow-up, 15/15 patients, (p < 0.001) presented without dysphagia. There was no adverse event related to the dilation or PRP administration.
Conclusions:
The excellent response after endoscopic-guided PRP intralesional administration represents an effective and safe alternative for refractory COS children.
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