ABSTRACT
Hirschsprung's associated enterocolitis (HAEC) is the most serious and potentially fatal complication of the disease, with a significant morbidity and mortality. The effect of HAEC varies remarkably among the publications since the lack of consensus and the absence of established diagnostic criteria. Patients diagnosed with Hirschsprung's disease (HD) were selected and treated between January 2009 and December 2012 in Fundación HOMI, finding 41 cases of HD, 6 of them with total aganglionosis. 76% of the patients had HAEC, 18 of them during the neonatal period and 6 of them after the final pull-through; 23% presented recurrent enterocolitis episodes. HAEC was the first clinical manifestation in 25 (61%) of the patients with HD. From HD patients limited to the rectum and sigmoid 67% had enterocolitis unlike TCA (total colonic agangliniosis) cases in which all presented HAEC episodes. In our setting, HAEC remains to be an unknown complication; this revision demonstrates its high incidence and mortality.
La enterocolitis asociada a la enfermedad de Hirschsprung (EAEH) es la complicación más grave y potencialmente fatal de la enfermedad, con una morbilidad y mortalidad significativas. La incidencia de EAEH varía notablemente entre las publicaciones dada la falta de consenso y la ausencia de criterios diagnósticos establecidos. Se seleccionaron los pacientes con diagnóstico de enfermedad de Hirschsprung (EH) tratados entre Enero de 2009 a Diciembre de 2012 en la Fundación Hospital de La Misericordia (HOMI) encontrando 41 casos de EH, 6 de ellos con aganglionosis total. En el 76% de los pacientes se realizó el diagnóstico de EAEH, 18 de ellos en el periodo neonatal y 6, tras el descenso definitivo; 23% presentaron episodios de enterocolitis recurrente. La EAEH fue la primera manifestación clínica en 25 (61%) de los pacientes con EH. De los pacientes con EH limitada al recto y sigmoides, un 67% tuvieron enterocolitis a diferencia de los casos de aganglionosis total del colon (ATC), donde todos presentaron episodios de EAEH.
ABSTRACT
OBJETIVOS: Evaluar la eficacia y seguridad de la dilatación endoscópica con balón en niños con estenosis esofágica. PACIENTES Y MÉTODOS: Estudio retrospectivo de pacientes tratados en los últimos 5 años, con diagnóstico de estenosis esofágica. La respuesta a la dilatación fue considerada como excelente cuando con una sola sesión no hubo disfagia recurrente, satisfactoria cuando precisaron hasta 5 sesiones, aceptable con más de 5 sesiones, e inadecuada si no hubo mejoría de la disfagia con las dilataciones. El tratamiento fue efectivo cuando la disfagia grado 0 o 1 se mantuvo por más de 12 meses desde la última sesión. RESULTADOS: Fueron realizados 576 procedimientos en 89 niños, promedio de 6,47 por paciente (rango 1-33). La estenosis era secundaria a la reparación de una atresia esofágica en 51 casos (57,3%), a lesión por cáusticos en 19 pacientes (21,3%) y a reflujo gastroesofágico 11 casos(12,3%); con edades comprometidas entre 1 a 202 meses (media de36,1). La respuesta a la dilatación fue excelente en 11 pacientes (13,9%),satisfactoria en 27 (34,1%), aceptable en 25 (31,6%), e inadecuada en16 (20,2%). Diez pacientes (8,9%) fueron perdidos durante el seguimiento. Fueron diagnosticados de reflujo gastroesofágico patológico concomitante 34 pacientes (38,2%), todos recibieron manejo médico y 7 requirieron cirugía antirreflujo (20,5%). El tratamiento fue efectivo en 63 casos (79,7%) e inefectivo en 16 (20,2%), la mayoría de estos últimos con reflujo gastroesofágico. Tuvieron lugar 8 complicaciones (1,38%), todas perforaciones esofágicas. CONCLUSIONES: La dilatación endoscópica con balón es considerada segura y efectiva como el tratamiento de primera línea para estenosis esofágica
OBJECTIVES: To evaluate the effectiveness and safety of endoscopic balloon dilatation in children with esophageal stenosis. Patients and Methods. Retrospective study of patients treated in the last 5 years, diagnosed with esophageal stricture. Response to dilatation was defined as excellent when there was no need for any additional dilatation for recurrent dysphagia, satisfactory when they set out to 5 sessions, acceptable with more than 5 sessions, and inadequate if there was no improvement of dysphagia with dilation. The treatment was effective when dysphagia remained grade 0 or 1 was kept for more than 12 months after the last dilatation session. RESULTS: 576 procedures were performed in 89 children, with an average of 6,47 per patient (range 1-33). The esophageal stenosis was secondary to esophageal atresia repair in 51 cases (57,3%), injury by caustic in 19 patients (21,3%) and gastroesophageal reflux 11 cases (12,3%); compromised aged between 1-202 months (mean 36,1). Re-sponse to dilatation was excellent in 11 patients (13.9%), satisfactory in 27 (34.1%), fair in 25 (31.6%), and inadequate in 16 (20.2%). Ten patients (8.9%) were lost to follow up. Thirty-four (38.2%) patients were diagnosed with concomitant gastroesophageal reflux disease, every one recieved medical management and 7 (20,5%) underwent antireflux surgery. The treatment was effective in 63 cases (79.7%) and ineffective in 16 (20.2%), most of the latter with gastroesophageal reflux. There were 8 complications (1,38%), all esophageal perforations .Conclusions. Endoscopic balloon dilatation can be accomplished safely and effectively as a first-line therapy for the management of esophageal stenosis
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Esophageal Stenosis/surgery , Dilatation/methods , Esophagoscopy/methods , Gastroesophageal Reflux/complications , Esophageal Atresia/complications , Patient SafetyABSTRACT
OBJECTIVES: To evaluate the effectiveness and safety of endoscopic balloon dilatation in children with esophageal stenosis. PATIENTS AND METHODS: Retrospective study of patients treated in the last 5 years, diagnosed with esophageal stricture. Response to dilatation was defined as excellent when there was no need for any additional dilatation for recurrent dysphagia, satisfactory when they set out to 5 sessions, acceptable with more than 5 sessions, and inadequate if there was no improvement of dysphagia with dilation. The treatment was effective when dysphagia remained grade 0 or 1 was kept for more than 12 months after the last dilatation session. RESULTS: 576 procedures were performed in 89 children, with an average of 6,47 per patient (range 1-33). The esophageal stenosis was secondary to esophageal atresia repair in 51 cases (57,3%), injury by caustic in 19 patients (21,3%) and gastroesophageal reflux 11 cases (12,3%); compromised aged between 1-202 months (mean 36,1). Response to dilatation was excellent in 11 patients (13.9%), satisfactory in 27 (34.1%), fair in 25 (31.6%), and inadequate in 16(20.2%). Ten patients (8.9%) were lost to follow up. Thirty-four (38.2%) patients were diagnosed with concomitant gastroesophageal reflux disease, every one recieved medical management and 7 (20,5%) underwent antireflux surgery. The treatment was effective in 63 cases (79.7%) and ineffective in 16 (20.2%), most of the latter with gastroesophageal reflux. There were 8 complications (1,38%), all esophageal perforations. CONCLUSIONS: Endoscopic balloon dilatation can be accomplished safely and effectively as a first-line therapy for the management of esophageal stenosis.
