Research progress on esophageal stents for children / 上海交通大学学报（医学版）

Currently, benign esophageal stricture is a common clinical esophageal disease in children, and its common treatment is balloon dilatation. According to the complexity of the lesion, the child often suffers from multiple esophageal dilation. Besides, esophageal stent provides a new choice for the treatment of esophageal stricture in children because of the long-lasting support. However, the complications limit its clinical application, such as chest pain, restenosis, and stent displacement. This article reviewed the current research and clinical application of esophageal stents for children.

Effects of 32P intracavitary irradiation on scar formation in benign esophageal strictures / 西安交通大学学报(医学版)

Objective To establish a benign esophageal stricture model and observe the effect of 32P radioactive isotopes on benign esophageal stricture scarring with intracavitary irradiation so as to provide experimental evidence for inhibiting scar hyperplasia and preventing esophageal restenosis after endoscopic dilation for benign esophageal stricture.Methods Benign esophageal stricture models were established in 18 healthy adult rabbits by annular incision and anastomosis.Then the rabbits were randomly divided into control group,hormone group and irradiation group,with six rabbits in each group.On day 2 after surgery,we measured inner diameter of the anastomotic stoma;then the control group received saline intervention,the hormone group was given dexamethasone,and the irradiation group was given 32P radioactive isotopes.The rabbits were observed for two weeks for their general condition and weight.After the intervention,we measured inner diameter of the anastomotic stoma.Liver functions (ALT and AST) were tested again before modeling and after intervention.Then the rabbits were put to death and had tissue in the esophageal stricture area removed for pathological examination and esophageal HE staining.We determined hydroxyproline (HYP) content of esophageal tissue around the anastomotic stoma.Restlts Benign esophageal stricture model was established successfully.After 2 weeks,the rabbits' appetite was obviously diminished in control group and relatively poor in hormone group;obviously improved in irradiation group.The rabbits' weight increased in radiation group compared with the other two groups (P＜0.05).The esophageal inner diameter in irradiation group widened obviously compared with the other two groups (P ＜ 0.05).In irradiation group,the number of fibroblasts decreased obviously,collagen fiber and granulation tissue were not obvious;HYP content was lower than that in the other two groups,and was close to that in a normal esophagus (P＞0.05).ALT and AST did not differ before and after intervention in all groups (P＞0.05).Conclusion ① We can establish benign esophageal stricture model successfully through the surgery.② 32Pradioactive isotopes radiation therapy can be used to prevent early scar formation in esophageal benign stricture,and is superior to dexamethasone therapy.

Therapeutic effect of endoscope-guided bougie dilatation on benign esophageal stricture in children / 中华消化内镜杂志

Objective To investigate therapeutic effect of endoscope?guided bougie dilatation on children with benign esophageal stricture. Methods Data of 71 patients with benign esophageal stricture were retrospective analyzed.Patients were divided into group A (reflux stricture),B (congenital esophageal atresia stricture) and C ( caustic injuries stricture) ,based on different causes. The expansion effectiveness and factors of the three groups were analyzed. Results A total of 885 expansions were performed on 71 patients with the total efficacy rate 94?37%( 67/71) . No statistic differences were shown in expansion effectiveness among the 3 groups; group C ( 14?9 times/case, P < 0?05 ) showed more expansion frequencies than group A (9?1 times/case,P<0?05)and group B(10?7 times/case, P<0?05),more complications than group A(1?22%VS 0,P<0?05) and group B(1?22% VS 0?31%,P<0?05). Conclusion Endoscope?guided bougie dilatation is safe and effective for childrens′ benign esophageal stricture. Caustic injuries, refractory benign esophageal stricture,need more expansions and may be accompanied with more complications.

Progress of Endoscopic Treatment for Benign Esophageal Strictures / 中国微创外科杂志

[Summary] Benign esophageal strictures can arise from various causes and mainly induce dysphagia .Commonly , the majority of benign esophageal strictures can achieve long-term relief through about three dilation sessions .However, some refractory benign esophageal strictures require other treatments , such as endoscopic stent placement and intralesional drug injection , but these treatments just attain short-time satisfactory results with a disappointingly low rate of long-term improvement.Recently, biodegradable stents and drug-eluting stents are developing and have obtained the positive effects .In this paper , we performed a review about the treatment of benign esophageal strictures .

Estenosis esofágica por Histoplasma: manejo con prótesis metálica autoexpandible / Management of Esophageal Stenosis Due to Histoplasma with Self-expanding Metal Stents

Las estenosis esofágicas benignas son una causa común de consulta en los servicios de endoscopia y gastroenterología. Usualmente, dada su naturaleza no neoplásica, estas se han manejado con dilataciones endoscópicas a repetición, incómodas y costosas para el paciente, dada su constante repetición; además de tener siempre el riesgo de perforación esofágica en cada sesión. El uso de prótesis esofágicas para manejo de las estenosis esofágicas benignas viene en progresivo aumento con resultados prometedores para varias de las etiologías de este tipo de obstrucciones. Presentamos el caso de una estenosis esofágica benigna secundaria a infección por Histoplasma capsulatum, manejada con una prótesis metálica totalmente cubierta con resolución completa de la obstrucción.

Benign esophageal strictures are a common cause of medical consultation and gastroenterological endoscopy. Usually, given their non-neoplastic nature, they have been managed with recurrent endoscopic dilation which is uncomfortable for the patient and which generates high costs due repetition. In addition, there is always the risk of esophageal perforation at every session. The use of esophageal stents for management of benign esophageal strictures is becoming increasingly more common and is promising for various etiologies. We present a case of a benign esophageal stricture secondary to infection with histoplasma capsulatum which was managed entirely with a completely covered metal stent. This led to complete resolution of the obstruction.

The application of drug-eluting biodegradable magnesium alloy stent in treating esophageal benign stricture:current research status and prospect / 介入放射学杂志

Stent implantation plays a more and more important role in the treatment of benign esophageal stenosis. Metal stents are most commonly used in the clinical practice, which can be classified into permanent stents and temporary retrieval stents. Permanent implantation of metal stents is easy to cause complications such as inflammatory hyperplasia, in-stent restenosis, perforation, bleeding, etc. Temporary retrieval stents should be removed with one week after it is implanted in order to avoid esophageal scar tissue repair and in-stent tissue hyperplasia, which can cause difficulty in its removing and produce higher recurrence rate of esophageal restenosis. Clinically, drug-eluting stents have already been used in cardiovascular system procedures, but at present the gastrointestinal drug-eluting stents are still in development and animal experiment stage. Biodegradable magnesium alloy stents have been widely employed in cardiovascular system procedures. With the rapid development of biological engineering materials, drug-eluting magnesium alloy stent has become a hot spot and the frontier in research field. This paper aims to make a comprehensive review about the current research status and prospect of the drug-eluting magnesium alloy stents, focusing on the stent technology, stent molding, coating modification, and the treatment of drug-eluting.

A Case of Aortoesophageal Fistula Complicated by a Stent for Benign Esophageal Stricture / 대한소화기내시경학회지

Self-expandable metallic stents (SEMS) are widely used for the palliative treatment of malignant strictures of the gastrointestinal tract. Recently, several studies tested whether a SEMS is an effective and safe option for benign esophageal stricture. Serious complications such as hemorrhage, compression of the bronchus, bronchoesophageal fistula, and esophageal rupture were infrequently encountered as complications of esophageal stent placement. Aortoesophageal fistula is extremely rare as a complication of esophageal SEMS insertion; only seven cases have been reported worldwide. We now report a case of an 80-year old female with aortoesophageal fistula after placement of a SEMS for an esophageal stricture.

A Case of Refractory Esophageal Stricture Induced by Lye Ingestion and Treated by Temporary Placement of Newly Designed Self-Expanding Metal Stent and Wetting with Mitomycin C / 대한소화기내시경학회지

Ingestion of strong acids or strong alkalies may produces severe inflammation on the mucosa of the esophagus and this may also causes esophageal stricture. Several forms of non-operative dilatations have been utilized for the treatment of esophageal stricture and they have shown good results. Yet some patients do not achieve acceptable symptom relief despite of intensive dilatation. Temporary placement of esophageal stent has recently been used in some of these patients. Furthermore, mitomycin C has been used as a conservative treatment for refractive esophageal stricture in children, yet its efficacy has not been well established. We experienced a case of a 64-year old man with severe, recurrent esophageal stricture, and this was successfully managed by temporary placement of an esophageal stent, together with a spray of mitomycin C. We report on this case along with the review of the literature.

The Treatment Effect of Savary Bougie Dilation in Benign Esophageal Strictures / 대한소화기내시경학회지

BACKGROUND/AIMS: Bougie dilatation is generally considered to be effective treatment of benign esophageal stricture. However, sometimes its therapeutic effect was unsatisfactory, or symptom used to recur after treatment. We reviewed our data to evaluate the efficacy of bougie dilation, and examined the factors associated with the bougienation effect. METHODS: Fifty-five patients, who were diagnosed with a benign esophageal stricture, underwent bougie dilation, and were followed up for more than 6 months, and were retrospectively analyzed. The treatment effects were graded as 'cure', 'fair', 'poor', and 'no effect'. The factors which influenced the treatment effect were analyzed. RESULTS: For the patients of severe pre-dilatation symptoms, long stricture lesion, and severe endoscopic stricture, the therapeutic effect of bougienation was significantly bad (p=0.002, 0.001, 0.019). Therapeutic effect was higher in patients who were treated with large diameter dilator in the first session (p=0.005), and has stronger relation with the length of stricture than the degree of stricture. In the follow-up period, 45 (81.8%) of 56 patients has achieved cure response. In the cure response group, 30 patients (66.7%) needed one, 5 (11.1%) needed two, 5 (11.1%) needed three, 3 (6.7%) needed four, 1 (2.2%) needed five, and the last one (2.2%) needed six sessions of bougienation. CONCLUSIONS: The luminal diameter of the stricture, the length of the stricture and the diameter of the dilator used in the initial session were associated with treatment effect. Bougie dilatation was reconfirmed to be effective treatment modality for benign esophageal stricture.

Factors Affecting the Response to Endoscopic Dilatation Therapy for Benign Esophageal Stricture / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic dilatation is an effective therapy for benign esophageal stricture. We analyzed the factors related to the endoscopic dilatation therapy in patients with benign esophageal strictures such as etiology, grade of dysphagia, length of stricture and number of therapeutic sessions. METHODS: We retrospectively analyzed the data of 63 patients who received endoscopic esophageal dilatation therapy due to benign esphageal strictures. RESULTS: The grade of dysphagia number was associated with the length of strictures (p=0.012) and therapeutic session (p=0.005). There was a statistically significant correlation between the length of strictures and therapeutic session number (p=0.001). There was no statistical difference in grade of dysphagia or the length of stricture according to the cause of strictures of therapeutic sessions performed. In corrosive stricture, the higher grade of dysphagia, was associated with the in creased number (p=0.028). The length of stricture was longer (p=0.040) and the number of therapeutic sessions were increased (p=0.026) in corrosive stricture than other etiologies. CONCLUSIONS: Corrosive esophageal stricture shows long stricture segment and needs increased number of therapeutic session as compared to other etiologies. However, corrosive esophageal stricture can be effectively treated with careful technique and increased number of endoscopic dilatation sessions.

A Comparison Between Savary - Gilliard and Balloon Dilatation in Benign Esophageal Stricture / 대한소화기내시경학회지

The balloon dilatation or Savary-Gilliard dilatation was performed in 59 patients with benign esophageal stricture in Chungnam National University Hospital from September 1990 to August 1995. We reviewed the effect and the safty of each therapeutic method and the results were as foillows: 1) The cause of stricture were corrosive stricture(28 cases, 49,4%), anastomotic stenosis after gastroesophageal surgery(26 cases, 44.1%), stricture after endoscopic variceal sclerotherapy(3 cases, 5.1%), esophageal web(1 case, 1.7%) or stricture complicated by reflux esophagitis(l case). 2) The overall cure rate of balloon dilatation was 50%(l2/24 cases) and that of Savary-Gilliard dilatation was 77.1%(27/35 cases). The Savary-Gilliard dilatation group had a better result than the balloon group. 3) The perforation after Savary-Gilliard dilatation occurred in 4 cases~(6.7%). One case was treated surgically and three cases wiere treated medically. But there was no fatal complication. 4) The overall cure rate of anastomotic stenosis was 84.6%(32/38 cases) and that of corrosive stricture was 46.4%(13/28 cases). 5) The cure rate of Savary-Gilliard dilatation in corrosive esophageal stricture was 64.7%(ll/17) and that of balloon dilatation was 18.1%(2/11). 6) According to site of stricture, the cure rate of dilatation was 84.2% (32/38) in thoracic esophagus, 42.8%(3/7) in cervical esophagus and 28,5%(4/14) in multiple or long segmented stricture.(continue...)