1
|
Gerrish AW, Kalmar CL, Yeaton P, Safford SD. Endoscopic biliary stent placement for anastomotic stricture following esophageal atresia repair in infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
|
2
|
Tambucci R, Angelino G, De Angelis P, Torroni F, Caldaro T, Balassone V, Contini AC, Romeo E, Rea F, Faraci S, Federici di Abriola G, Dall'Oglio L. Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures. Front Pediatr 2017; 5:120. [PMID: 28611969 PMCID: PMC5447026 DOI: 10.3389/fped.2017.00120] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/04/2017] [Indexed: 01/10/2023] Open
Abstract
Improved surgical techniques, as well as preoperative and postoperative care, have dramatically changed survival of children with esophageal atresia (EA) over the last decades. Nowadays, we are increasingly seeing EA patients experiencing significant short- and long-term gastrointestinal morbidities. Anastomotic stricture (AS) is the most common complication following operative repair. An esophageal stricture is defined as an intrinsic luminal narrowing in a clinically symptomatic patient, but no symptoms are sensitive or specific enough to diagnose an AS. This review aims to provide a comprehensive view of AS in EA children. Given the lack of evidence-based data, we critically analyzed significant studies on children and adults, including comments on benign strictures with other etiologies. Despite there is no consensus about the goal of the luminal diameter based on the patient's age, esophageal contrast study, and/or endoscopy are recommended to assess the degree of the narrowing. A high variability in incidence of ASs is reported in literature, depending on different definitions of AS and on a great number of pre-, intra-, and postoperative risk factor influencing the anastomosis outcome. The presence of a long gap between the two esophageal ends, with consequent anastomotic tension, is determinant for stricture formation and its response to treatment. The cornerstone of treatment is endoscopic dilation, whose primary aims are to achieve symptom relief, allow age-appropriate capacity for oral feeding, and reduce the risk of pulmonary aspiration. No clear advantage of either balloon or bougie dilator has been demonstrated; therefore, the choice is based on operator experience and comfort with the equipment. Retrospective evidences suggest that selective dilatations (performed only in symptomatic patients) results in significantly less number of dilatation sessions than routine dilations (performed to prevent symptoms) with equal long-term outcomes. The response to dilation treatment is variable, and some patients may experience recurrent and refractory ASs. Adjunctive treatments have been used, including local injection of steroids, topical application of mitomycin C, and esophageal stenting, but long-term studies are needed to prove their efficacy and safety. Stricture resection or esophageal replacement with an interposition graft remains options for AS refractory to conservative treatments.
Collapse
Affiliation(s)
- Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,University of L'Aquila, L'Aquila, Italy
| | - Giulia Angelino
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola De Angelis
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Filippo Torroni
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valerio Balassone
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Chiara Contini
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Erminia Romeo
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Rea
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simona Faraci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Luigi Dall'Oglio
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
3
|
Raitio A, Cresner R, Smith R, Jones MO, Losty PD. Fluoroscopic balloon dilatation for anastomotic strictures in patients with esophageal atresia: A fifteen-year single centre UK experience. J Pediatr Surg 2016; 51:1426-8. [PMID: 27032608 DOI: 10.1016/j.jpedsurg.2016.02.089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/28/2016] [Accepted: 02/17/2016] [Indexed: 01/21/2023]
Abstract
AIM OF THE STUDY To assess the safety and effectiveness of fluoroscopic balloon dilatation (FBD) in children with esophageal anastomotic stricture after surgical repair of esophageal atresia. METHODS All patients undergoing surgery for esophageal atresia and requiring dilatation(s) during a consecutive 15-year period [April 2000-September 2014] were analyzed. Dilatations were performed as day case procedures under general anesthesia using a radial force generating balloon device (Boston Scientific Corporation) by surgeons. Outcomes assessed included - (1) the number of dilatations/patient, (2) effectiveness and (3) need for surgery and (4) complications. RESULTS One hundred thirty seven patients underwent 625 FBD sessions (median 3 dilations per patient; range 1-24 dilatations). Median age at 1st FBD was 0.74years (range 0.05-16.1years). Balloon catheter sizes ranged from 6mm to 20mm. FBD yielded excellent results in 99 patients (74%), while 17 cases (13%) had mild ongoing dysphagia/dysmotility. Ten patients (7%) required further dilatation(s) to control symptoms. No patient(s) required esophageal stenting. Five cases required G-tube feeds as a result of oral aversion behavior - all of these cases were complex/VACTERL patients. Only 1 minor radiological leak occurred after a dilatation session and this did not require surgical intervention. A single patient (long gap EA TEF) with severe neurological impairment having multiple dilatations and stricture resection ultimately required esophageal replacement. Anti-reflux surgery was performed in 36 patients (26%) for medical therapy resistant GER. CONCLUSION FBD for anastomotic stricture(s) following esophageal atresia repair achieved very good outcomes for the majority of EA TEF patients. The procedure can be accomplished safely as indicated by the low complication rate herein reported. Although some children may require more than one dilatation session prompt relief of symptoms can be achieved with a vigilant care program co-ordinated by a multidisciplinary specialist EA TEF team.
Collapse
Affiliation(s)
- Arimatias Raitio
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - Rosie Cresner
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - Richard Smith
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - Matthew O Jones
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - Paul D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; Academic Paediatric Surgery Unit, Institute of Child Health, University of Liverpool, UK.
| |
Collapse
|
4
|
Lehtovirta J, Kiekara O, Soimakallio S. Balloon Dilatation of Esophageal Strictures in Children with a Simplified Technique. Acta Radiol 2016. [DOI: 10.1177/028418519203300220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J. Lehtovirta
- Departments of Radiology and Clinical Radiology, Kainuu Central Hospital, Kajaani, and Kuopio University Hospital, Kuopio, Finland
| | - O. Kiekara
- Departments of Radiology and Clinical Radiology, Kainuu Central Hospital, Kajaani, and Kuopio University Hospital, Kuopio, Finland
| | - S. Soimakallio
- Departments of Radiology and Clinical Radiology, Kainuu Central Hospital, Kajaani, and Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
5
|
Manfredi MA. Endoscopic Management of Anastomotic Esophageal Strictures Secondary to Esophageal Atresia. Gastrointest Endosc Clin N Am 2016; 26:201-19. [PMID: 26616905 DOI: 10.1016/j.giec.2015.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The reported incidence of anastomotic stricture after esophageal atresia repair has varied in case series from as low as 9% to as high as 80%. The cornerstone of esophageal stricture treatment is dilation with either balloon or bougie. The goal of esophageal dilation is to increase the luminal diameter of the esophagus while also improving dysphagia symptoms. Once a stricture becomes refractory to esophageal dilation, there are several treatment therapies available as adjuncts to dilation therapy. These therapies include intralesional steroid injection, mitomycin C, esophageal stent placement, and endoscopic incisional therapy.
Collapse
Affiliation(s)
- Michael A Manfredi
- Esophageal and Airway Atresia Treatment Center, Boston Children's Hospital, Boston, MA 02132, USA; Pediatrics Harvard Medical School, Boston, MA 02115, USA.
| |
Collapse
|
6
|
Thyoka M, Barnacle A, Chippington S, Eaton S, Drake DP, Cross KMK, De Coppi P, Kiely EM, Pierro A, Curry JI, Roebuck DJ. Fluoroscopic Balloon Dilation of Esophageal Atresia Anastomotic Strictures in Children and Young Adults: Single-Center Study of 103 Consecutive Patients from 1999 to 2011. Radiology 2014; 271:596-601. [DOI: 10.1148/radiol.13122184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
7
|
Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia: a systematic review. Pediatr Radiol 2013; 43:898-901; quiz 896-7. [PMID: 23877544 DOI: 10.1007/s00247-013-2693-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/26/2013] [Accepted: 02/13/2013] [Indexed: 01/21/2023]
Abstract
Surgical repair of oesophageal atresia may result in anastomotic strictures. These strictures are often treated by balloon dilatation (BD) and currently balloon dilatation (fluoroscopic or endoscopic) is the preferred primary treatment method. Here we review the current evidence of the outcomes of balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia. We searched the standard databases (January, 1960-May, 2012) to identify all studies that reported outcomes of balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia in children. Data, reported as median (range), were analysed and compared. Outcomes were success of BD, number of BD sessions, number of oesophageal perforations, need for other surgical interventions and mortality. Five studies were found to be relevant (n = 139; 81 [58%] male children). The total number of dilatation sessions was 401 (2.9 dilatations per child patient). General anaesthesia was used in two (40%) studies; sedation in a further two (40%) studies and one (20%) study used a combination of both. The size of balloon catheter ranged from 4 mm to 22 mm. Seven perforations were reported (1.8% per dilatation session), of which only one (14%) required surgery. No deaths were recorded. Balloon dilatation for anastomotic strictures post-EA repair is safe, and associated with a low perforation and mortality rates. Most perforations are amenable to conservative management.
Collapse
|
8
|
Ko HK, Shin JH, Song HY, Kim YJ, Ko GY, Yoon HK, Sung KB. Balloon Dilation of Anastomotic Strictures Secondary to Surgical Repair of Esophageal Atresia in a Pediatric Population: Long-term Results. J Vasc Interv Radiol 2006; 17:1327-33. [PMID: 16923980 DOI: 10.1097/01.rvi.0000232686.29864.0a] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the clinical effectiveness and long-term results of balloon dilation treatment for strictures secondary to surgical repair of esophageal atresia (EA) in 29 children. MATERIALS AND METHODS The study involved 29 children aged 1-60 months with strictures of greater than 50% at anastomotic sites. The interval between surgical repair and balloon dilation ranged from 1 to 36 months (mean, 6.4 months). All procedures were performed under general anesthesia with use of fluoroscopic guidance. Balloon catheter diameters ranged from 8 mm to 16 mm. Outcome parameters measured included the number of dilations, procedural success rates, primary and secondary clinical success rates, and complications such as esophageal perforation. Primary clinical success was defined as an absence of dysphagia for at least 1 year and weight gain appropriate to the patient's age after initial balloon dilation. Secondary clinical success was defined as an absence of dysphagia for at least 1 year after the final dilation and weight gain appropriate to the patient's age after one or more balloon dilation sessions. RESULTS A total of 44 balloon dilation sessions were performed, with patients undergoing one to five dilation procedures (mean, 1.6 per patient; median, 1 per patient). Primary and secondary clinical success rates were 59% (17 of 29) and 93% (27 of 29), respectively. During the mean follow-up period of 3.1 years (range, 1-12 y), all 27 children with clinical success showed no recurring symptoms. In terms of complications, transmural perforation occurred in three children (10%), two of whom received conservative management and one of whom underwent surgery for combined esophageal rupture and esophagotracheal fistula. No mortalities occurred. CONCLUSION Balloon dilation is a safe and effective procedure with excellent long-term results for the treatment of anastomotic strictures secondary to surgical repair of EA in a pediatric population.
Collapse
Affiliation(s)
- Heung-Kyu Ko
- Department of Radiology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea
| | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
The aim of the study is to evaluate the indications, safety, and efficacy of endoscopy guided balloon dilatation (EGBD) in the treatment of strictures of the oesophagus in children. Between 1998 and 2002, 12 infants and children with oesophageal strictures were treated with EGBD in our institute. Median age was 4.1 years (range, 2 months-11 years). Of 12 patients, four had oesophageal strictures, following repair of oesophageal atresia; six had short-segment caustic strictures; and two had anastomotic strictures after oesophageal replacement (colon, 1; stomach, 1). All patients had previously failed to respond to conventional bouginage (mean, 6 sessions; range 2-14). All patients underwent contrast studies before EGBD. EGBD was performed using flexible endoscopy and fluoroscopic screening under general anaesthesia. The mean number of EGBD procedures per patient was six (range 4-10). The functional results were complete in ten and temporary in two patients. There has been no morbidity or mortality. EGBD is safe and effective for treating oesophageal anastomotic and short-segment caustic strictures.
Collapse
|
10
|
Lan LCL, Wong KKY, Lin SCL, Sprigg A, Clarke S, Johnson PRV, Tam PKH. Endoscopic balloon dilatation of esophageal strictures in infants and children: 17 years' experience and a literature review. J Pediatr Surg 2003; 38:1712-5. [PMID: 14666449 DOI: 10.1016/j.jpedsurg.2003.08.040] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Whereas endoscopic balloon dilatation (EBD) of benign esophageal strictures is an established mode of therapy in adults, this has not been accepted universally in the pediatric population. The aim of this study is to report the safety, efficacy, and long-term results of EBD for children in the authors' center. METHODS Between 1986 and 2002, a total of 77 children (median age, 1.8 years; range, 2 months to 20 years) were treated by EBD for various causes: 2 had achalasia, and 75 had esophageal strictures (postesophageal atresia repair, 63; reflux esophagitis, 7; postfundoplication, 2; caustic injury, 3). Dilatations were performed using flexible endoscopy and fluoroscopic screening under general anesthesia. RESULTS A total of 260 dilatations were carried out with the mean number of EBD per patient being 3.4 (range, 1 to 19). A mean period of 5 months (maximum, 28 months) for each patient was required. Four complications of esophageal perforations (1.5%) were observed, but only one required surgical repair because of persistent leakage. The remaining patients have undergone long-term follow-up (median follow-up, 6.6 years), and all are asymptomatic. CONCLUSIONS This large series has shown that EBD can provide a safe and effective mean of relieving esophageal strictures with good long-term results.
Collapse
Affiliation(s)
- L C L Lan
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
11
|
John P. Thoracic interventional radiology in children. Paediatr Respir Rev 2001; 2:131-44. [PMID: 12531060 DOI: 10.1053/prrv.2000.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Significant technological advancements have been achieved in radiology with the introduction of a branch speciality known as interventional radiology. Radiology has moved into the therapeutic arena, performing minimally invasive diagnostic and therapeutic procedures. The interventional radiologist can treat certain vascular and non-vascular conditions with "keyhole" or perhaps more correctly "pinhole" techniques using catheter-based technology directed under image guidance with X-ray (including computed tomography), ultrasound and magnetic resonance imaging. Interventional radiology can provide new treatment options for children not possible a few years ago.
Collapse
Affiliation(s)
- P John
- Birmingham Children's Hospital NHS Trust, UK.
| |
Collapse
|
12
|
Michaud L, Guimber D, Sfeir R, Rakza T, Bajja H, Bonnevalle M, Gottrand F, Turck D. [Anastomotic stenosis after surgical treatment of esophageal atresia: frequency, risk factors and effectiveness of esophageal dilatations]. Arch Pediatr 2001; 8:268-74. [PMID: 11270250 DOI: 10.1016/s0929-693x(00)00193-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
UNLABELLED Anastomotic stricture is the most common complication following the surgical repair of esophageal atresia, and is usually treated by esophageal dilation. OBJECTIVES The aims of this study were to assess in an infant population operated on at birth for type III or IV esophageal atresia: 1) the frequency of esophageal stenosis following the repair of esophageal atresia, and associated factors; 2) the efficacy of esophageal dilation by the Savary-Gaillard bougie technique. MATERIALS AND METHODS The medical records of 52 children presenting with esophageal atresia over a 5-year period were retrospectively reviewed. Gestional age and birth weight, duration of mediastinal and transanastomotic drainage, and anastomotic complications including leakage, stricture, and the presence of gastroesophageal reflux were recorded and analysed. Patients presenting with anastomotic stricture were compared with a group of children without stricture. The number of esophageal dilations, their efficacy and the complication rate were analyzed. RESULTS Anastomotic stricture developed in 20 (40%) of the 50 patients undergoing primary repair for esophageal atresia. The occurrence of anastomotic stricture was related to anastomotic tension during esophageal surgical repair (p < 0.03). Young children required esophageal dilation at a mean age of 142 days (24-930 days). Stricture resolution occurred after a mean of 3.2 dilations (1-15) over an average period of 7.9 months (range: 0-30 months). Dilation was successful in 90% of the 20 patients. Seven patients required only one dilation. Perforation of the esophagus occurred in one case, and this severe complication led to the death of the child. Esophageal dilation was unsuccessful in two patients, who presented prolonged severe dysphagia. CONCLUSION Anastomotic stricture following repair of esophageal atresia is connected with the length of the gap that has to be repaired, and tension during suture. Esophageal dilation by the Savary-Gaillard bougie technique is an effective method for treating esophageal stricture. Several dilations are usually needed before the disappearance of dysphagia.
Collapse
Affiliation(s)
- L Michaud
- Unité de gastro-entérologie, hépatologie et nutrition, clinique de pédiatrie, hôpital Jeanne-de-Flandre, 59037 Lille, France
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Allmendinger N, Hallisey MJ, Markowitz SK, Hight D, Weiss R, McGowan G. Balloon dilation of esophageal strictures in children. J Pediatr Surg 1996; 31:334-6. [PMID: 8708898 DOI: 10.1016/s0022-3468(96)90733-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Esophageal strictures in children may develop as a primary constriction, secondary to a surgically repaired esophageal atresia (with or without tracheoesophageal fistula), as a result of chemical injury after caustic ingestion, or following esophageal surgery. Traditional treatment of esophageal strictures has been limited to dilation (using bougie dilators) with esophagoscopy under general anesthesia. Recent reports have shown success with fluoroscopically guided balloon catheter dilation. Eight children (aged 2 months to 14 years) were treated with balloon catheter dilation for focal strictures of the esophagus. In six of the eight cases, complete resolution of the strictures was achieved after an average of 7.5 dilations (range, 1 to 14). Two of the eight patients moved to another part of the country and did not complete treatment. There has been no morbidity or mortality. In selected centers, balloon catheter dilation under fluoroscopic guidance has become a safe treatment of benign esophageal strictures in children. It should be considered the treatment of choice in the initial management of esophageal narrowing and appears to be safer than the more traditional methods of esophageal dilation.
Collapse
Affiliation(s)
- N Allmendinger
- Division of Vascular/Interventional Radiology, Hartford Hospital, CT 06106, USA
| | | | | | | | | | | |
Collapse
|
14
|
Huet F, Mougenot JF, Saleh T, Vannerom Y. [Esophageal dilatation in pediatrics: study of 33 patients]. Arch Pediatr 1995; 2:423-30. [PMID: 7640733 DOI: 10.1016/0929-693x(96)81176-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Esophageal dilatation is usually regarded as an effective therapy in a majority of esophageal stenosis in childhood. However, the limited number of pediatric data does not allow definite conclusions on indications and complications of such a procedure. PATIENTS AND METHODS The files of 33 children whose esophageal stenosis had been treated by dilatation by the same operator between 1983 and 1992 were retrospectively reviewed. The structure mechanisms were: group 1: repair of esophageal atresia (n = 9), group 2: caustic esophagitis (n = 6), group 3: peptic esophagitis (n = 12), group 4: unclassified structures (congenital esophageal stenosis, achalasia) (n = 6). The dilatations were performed under general anesthesia, and the dilatator guide was introduced under endoscopic control. Two methods were used: Savary esophageal bougies and balloon dilatation. A thoracic X-ray was systematically performed after each dilatation. RESULTS One hundred and fourteen dilatations (3.5 dilatations/child) were performed (range: 1-32 dilatations). Twenty-five of the 33 children (76%) were dramatically improved after mechanical dilatation. Esophageal dilatation was unsuccessful in the eight other patients, seven of them requiring a surgical repair. Complications occurred in 3.4% of the dilatations: one esophageal perforation, one pneumomediastinum and two cardiac arrests (one of vagal origin and 1 after accidental extubation). All patients survived. Efficacy, duration of dilatation and complication rates were not similar in the four groups. CONCLUSIONS Esophageal dilatation should be considered as a simple and effective procedure when strict security rules are respected by a trained operator.
Collapse
Affiliation(s)
- F Huet
- Service de gastroentérologie et nutrition pédiatrique, hôpital Robert-Debré, Paris, France
| | | | | | | |
Collapse
|
15
|
Jawad AJ, Al-Samarrai AI, Al-Rabeeah A, Al-Rashed R. The management of esophageal strictures in children. Ann Saudi Med 1995; 15:43-7. [PMID: 17587898 DOI: 10.5144/0256-4947.1995.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During a 10-year period from 1982 to 1992, 36 children and infants were treated for esophageal stricture. The severity of the stricture was indicated by the degree of feeding intolerance manifested by delays in growth and development and confirmed by fluoroscopy and endoscopy. Their ages ranged from one month to seven years. During the first eight years, the initial treatment was the conventional use of Savory dilators. Balloon dilatation was applied in all patients with esophageal stricture during the last two years. According to the etiology of the stricture, patients were divided into three groups. Group A: (seven patients) due to peptic esophagitis following persistent gastroesophageal reflux (GER). Group B: (15 patients) following ingestion of corrosive material. All had severe strictures; two had stomach outlet obstruction in addition. Group C: (14 patients) following repair of esophageal atresia. There was no mortality; however, overall morbidity was 5.5%, as one patient had esophageal perforation during the initial esophageal dilatation and one patient developed anastomotic leak.
Collapse
Affiliation(s)
- A J Jawad
- Divisions of Pediatric Surgery and Gastroenterology, College of Medicine, and King Khalid Hospital, Riyadh, Saudi Arabia
| | | | | | | |
Collapse
|
16
|
Shaffer HA, de Lange EE. Gastrointestinal foreign bodies and strictures: radiologic interventions. Curr Probl Diagn Radiol 1994; 23:205-49. [PMID: 7867376 DOI: 10.1016/0363-0188(94)90015-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Food impaction and foreign body ingestion are significant and sometimes life-threatening medical problems. As described in part 1 of this monograph, a variety of techniques and instruments are available to diagnose and treat these conditions. The radiologist interested in interventional procedures can find ample opportunities to participate in the management of esophageal obstructions by applying radiographic and fluoroscopic techniques to the diagnosis and removal of foreign bodies and food impactions. The recommended radiologic procedures are relatively safe, cost-effective, and efficient methods of addressing these serious situations. Stricture formation in the gastrointestinal tract is another significant medical problem that can often be managed nonoperatively by the radiologist. Fluoroscopically guided balloon dilatation has become an accepted method of effectively treating a large variety of strictures. As described in part 2 of this article, the technique is easy to perform, usually with very little inconvenience to the patient, and the risks of complications are very low. The procedure is relatively inexpensive and does not require the acquisition of any specialized or high-technology equipment. Also, the technique can be performed easily by any radiologist with interest in interventional procedures on the gut. A wide use of the fluoroscopic methods for treatment of impacted foreign bodies and strictures of the gastrointestinal tract is recommended.
Collapse
Affiliation(s)
- H A Shaffer
- Department of Radiology, University of Virginia, Charlottesville
| | | |
Collapse
|
17
|
Abstract
A total of 17 patients, ages 3 weeks to 14 1/2 years, had 20 esophageal strictures develop after repair of esophageal atresia (9 strictures); primary gastroesophageal reflux (3 strictures); Nissen fundoplication (4 strictures); epidermolysis bullosa congenita dystrophica (1 stricture); congenital esophageal stenosis (2 strictures); or colonic interposition (1 stricture). These strictures were treated with 132 endoscopic balloon catheter dilations (average, 6.6/patient, range, 1 to 24) during a period of 42 months (average, 8 months; range, 2 to 42 months). Fifteen of the 17 patients are now asymptomatic. Thirteen of the 17 patients had documented reflux esophagitis and were also medically treated. The two residually symptomatic patients included a patient with severe proximal esophagitis secondary to epidermolysis bullosa congenita dystrophica who had only a temporary response to dilations and another patient with a tight Nissen fundoplication who did not improve after dilation but is now asymptomatic after corrective surgery. The 10 patients with tracheoesophageal fistula repair were asymptomatic within 3 to 21 months (average, 10.8 months). Only one patient had perforation develop as a result of the procedure. Sixteen of 17 patients had the procedures performed as outpatients. All patients were given oral feedings throughout the course of dilation and had normal growth.
Collapse
Affiliation(s)
- M D Shah
- Medical College of Virginia/Virginia Commonwealth University, Department of Pediatrics, Richmond
| | | |
Collapse
|
18
|
Davies RP, Linke RJ, Davey RB. Retrograde esophageal balloon dilatation: salvage treatment of caustic-induced stricture. Cardiovasc Intervent Radiol 1992; 15:186-8. [PMID: 1628287 DOI: 10.1007/bf02735586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 14-month-old boy with severe esophageal strictures following ingestion of potassium hydroxide is described. Initially, treatment was by surgical bougienage but following esophageal perforation, 65 balloon dilatations were performed over an 8-month period using a retrograde approach via a feeding gastrostomy without anesthesia or sedation. A further nine dilatations in the following 6 months were performed using a per-oral approach after establishment of full oral nutrition and removal of the gastrostomy. The main advantage of the retrograde approach was the large number of dilatations that could be performed without anesthesia in an infant. This has allowed nonoperative treatment of a high grade caustic esophageal stricture which would otherwise have required esophageal replacement.
Collapse
Affiliation(s)
- R P Davies
- Department of Radiology, Flinders Medical Centre, Bedford Park, South Australia
| | | | | |
Collapse
|
19
|
Tam PK, Sprigg A, Cudmore RE, Cook RC, Carty H. Endoscopy-guided balloon dilatation of esophageal strictures and anastomotic strictures after esophageal replacement in children. J Pediatr Surg 1991; 26:1101-3. [PMID: 1941489 DOI: 10.1016/0022-3468(91)90682-j] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study evaluates the safety, efficacy, and technical problems of the new technique of endoscopy-guided balloon dilation (EGBD) in the treatment of strictures of the esophagus and its replacement. Between 1986 and 1990, the authors treated 33 children (aged 3 weeks to 20 years) with EGBD; 18 had esophageal strictures (primary esophageal atresia repair, 13; reflux esophagitis, 5), 13 had anastomotic strictures after esophageal replacement (colon, 12; stomach, 1), and 2 had caustic strictures. The majority (23 of 33) had previously failed to respond to conventional bouginage (mean, 11.2 sessions; range, 1 to 32 sessions). EGBD was performed using flexible endoscopy and flouroscopic screening under general anesthesia. Endoscopy identified and resolved the errors or uncertainties of preoperative contrast studies in 7 patients, 5 of whom had colon interposition. EGBD was achieved in all 31 patients with esophageal or replacement strictures; the mean number of EGDB procedures per patient was 2.1 (range 1 to 7). Symptomatic relief was excellent in 24 and moderate in 7 patients. Both patients with caustic strictures had esophageal perforation from EGBD (excessive inflation, 1; false passage of guide wire, 1). Patients who had experienced both conventional bouginage and EGBD noticed less pain with EGBD and resumed eating sooner. The authors conclude that EGBD is safe and effective for treating esophageal and replacement strictures but not caustic strictures.
Collapse
Affiliation(s)
- P K Tam
- Department of Pediatric Surgery, Royal Liverpool Children's Hospital Alder Hey, Liverpool, England
| | | | | | | | | |
Collapse
|
20
|
|
21
|
Dakkak M, Bennett JR. Balloon technology and its applications in gastrointestinal endoscopy. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1991; 5:195-208. [PMID: 1854987 DOI: 10.1016/0950-3528(91)90012-p] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
22
|
Rottermann EM, Julia MV, Rovira J, Pari FJ, Morales L. Esophageal stenosis following Stevens-Johnson syndrome. Treatment with balloon dilation. Clin Pediatr (Phila) 1990; 29:336-8. [PMID: 2361342 DOI: 10.1177/000992289002900609] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 5-year-old girl with Stevens-Johnson syndrome developed progressive dysphagia secondary to esophageal stenosis. The authors resolved this by treating the patient with balloon dilatation. She has remained symptom-free for 10 months post-treatment.
Collapse
Affiliation(s)
- E M Rottermann
- Servico de Cirurgia Pediatrica, Hospital Clinic, Barcelona, Spain
| | | | | | | | | |
Collapse
|
23
|
Cox JG, Winter RK, Maslin SC, Jones R, Buckton GK, Hoare RC, Sutton DR, Bennett JR. Balloon or bougie for dilatation of benign oesophageal stricture? An interim report of a randomised controlled trial. Gut 1988; 29:1741-7. [PMID: 3065156 PMCID: PMC1434110 DOI: 10.1136/gut.29.12.1741] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Seventy one patients with benign oesophageal strictures were randomised to receive balloon or bougie dilatation. Sixty five patients were eligible for analysis. At the end of five months the balloon group had significantly more dysphagia and the calibre of the strictures in the balloon group had narrowed by a greater degree. The methods were equally safe and acceptable to patients. While the choice of the method of dilatation depends on the individual patient's needs and operator experience, bougie dilatation is more effective in reducing dysphagia and maintaining stricture patency.
Collapse
Affiliation(s)
- J G Cox
- Department of Gastroenterology, Hull Royal Infirmary
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Hawkins DB. Dilation of esophageal strictures: comparative morbidity of antegrade and retrograde methods. Ann Otol Rhinol Laryngol 1988; 97:460-5. [PMID: 3052221 DOI: 10.1177/000348948809700505] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A total of 687 dilations of esophageal strictures were performed on 59 patients in the operating room over a 17-year period. Seventy-nine percent of the strictures were secondary to caustic ingestion and 89% of the dilations were in these patients. Antegrade dilations were performed 389 times and retrograde dilations were performed 298 times. Esophageal perforation occurred seven times with antegrade dilations. There were no perforations with retrograde dilations. The retrograde method using Tucker bougies is the safest and most successful method of dilating severe strictures.
Collapse
Affiliation(s)
- D B Hawkins
- Department of Otolaryngology-Head and Neck Surgery, Los Angeles County-University of Southern California Medical Center
| |
Collapse
|
25
|
Hoffer FA, Winter HS, Fellows KE, Folkman J. The treatment of post-operative and peptic esophageal strictures after esophageal atresia repair. A program including dilatation with balloon catheters. Pediatr Radiol 1987; 17:454-8. [PMID: 3684357 DOI: 10.1007/bf02388277] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Nine patients, 6 weeks to 17 years of age with esophageal atresia (EA), developed esophageal strictures and were treated with 26 balloon catheter dilatations over a period of 3 years; 6 are now asymptomatic. Five of the 9 patients had suspected reflux esophagitis, confirmed in 3 by biopsy and treated medically prior to dilatation. Seven of the 9 patients had a primary anastomosis, 1 a gastric tube, and 1 a colonic interposition. Most dilatations in the group of 7 were performed with balloon (B) greater than or equal to the diameter of the distal esophagus (E) (B/E greater than or equal to 1). The 3 residually symptomatic patients include an infant dilated conservatively (B/E less than 1) to facilitate later bouginage, 1 patient with a recurrent stricture after stopping medical therapy and home bouginage, and 1 infant who had a persistent anastomotic stricture, suspected but untreated reflux esophagitis, and a perforation during the second balloon dilatation. Balloon catheter esophageal dilatation, as an alternative to bouginage, is usually a safe and effective procedure when reflux esophagitis is diagnosed and treated prior to dilatation.
Collapse
Affiliation(s)
- F A Hoffer
- Department of Radiology, Children's Hospital, Harvard Medical School, Boston
| | | | | | | |
Collapse
|