RESUMEN
To investigate the efficacy and safety of endoscopic bougie dilation and stent implantation for pediatric caustic esophageal stenosis. Clinical characteristics, diagnosis and treatment of children with pediatric caustic esophageal stenosis from October 2009 to December 2019 at Department of Gastroenterology, the Seventh Medical Center of PLA General Hospital were retrospectively analyzed. A total of 50 caustic esophageal stenosis cases were enrolled, among whom, 94.0% (47/50) received conservative treatment before sending to our hospital. Thirty-six (72.0%) of them accidently ingested caustic substance of alkali and 22.0% (11/50) of them accidently ingested caustic substance of acid. Forty-six children (92.0%) who ingested caustic agents were younger than 7 years old. The stenosis was more common in the upper esophagus, accounting for 64.0% (32/50). Twenty-seven cases (54.0%) underwent simple bougie dilation and 16 cases (32.0%) underwent bougie dilation combined with stent treatment. All 50 children underwent a total of 1 260 expansions. The numbers of simple dilations and dilations combined with stent implantation were 37.8±26.2, 20.9±12.6 respectively with significant difference ( t=2.453, P=0.021). Among them, 2 cases (4.0%) underwent surgery, 5 cases (10.0%) underwent surgery combined with dilatation and stent implantation. The stenosis diameter widened significantly after treatment (1.1±0.2 cm VS 0.2±0.1 cm, t=23.004, P<0.001), and the Stooler grade of dysphagia improved significantly (grade 3.5±0.5 VS 1.2±0.7, t=19.925, P<0.001). Perforation occurred in only 1 patient, who was cured by conservative treatment with stent implantation. The total effective rate was 100.0% (50/50) and the satisfaction rate was 98.0% (49/50). Endoscopic bougie dilation and bougie dilation combined with stent implantation is safe and effective for pediatric caustic esophageal stenosis. Combination with stent implantation can reduce the number of dilation times.
RESUMEN
PURPOSE: This study was undertaken to evaluate the long-term treatment of esophageal strictures in children with corrosive esophagitis and to determine the effect of self-bougienage on recurrent strictures. MATERIALS AND METHODS: We reviewed the medical records of nine children that were treated for corrosive esophageal strictures from May 2000 to May 2008. Six males and three females were included and their average age was 30 months. Six patients had ingested acids, two patents had ingested alkali, and one ingested an unknown agent. RESULTS: The interval between caustic ingestion and esophageal stricture ranged from one to eight weeks. The average length of the esophageal strictures was 3.8 cm (range, 1 to 9.2 cm). Four patients had a long segment stricture (longer than 5 cm) and one patient had multiple strictures. The most common site of involvement was the upper third followed by the mid third of the esophagus. Eight patients received repeated dilatation using a balloon catheter or bougie dilator. Among the eight patients, two patients had complete resolution of symptoms and six patients required surgery. Among five patients that developed restenosis of the esophageal anastomosis site, three patients had improved symptoms after self-bougienage and two patients had improved symptoms with repeated balloon dilatation or endoscopic bougienage. There were no complications in these patients. CONCLUSION: Although a small number of patients were studied, self-bougienage was safe, less invasive, and effective for the management of esophageal restenosis in patients who required frequent dilation after surgery.