Endoscopic management of esophageal stenosis in children：New and traditional treatments

• 作者: Erminia Romeo Filippo Torroni Francesca Foschia Francesca Rea Giovanni Federici di Abriola Giulia Angelino Luigi Dall Oglio Paola De Angelis rsquo Simona Faraci Tamara Caldaro
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: ESOPHAGEAL STENOSIS ESOPHAGEAL STRICTURE ESOPHAGEAL DILATION ESOPHAGEAL stent CAUSTIC STRICTURE
• 年，卷（期）: 2016,（4）
• 页码范围: 212-219
• 页数: 8页
• 分类号: R

摘要

Post-esophageal atresia anastomotic strictures and postcorrosiveesophagitis are the most frequent types ofcicatricial esophageal stricture. Congenital esophagealstenosis has been reported to be a rare but typicaldisease in children; other pediatric conditions are peptic,eosinophilic esophagitis and dystrophic recessiveepidermolysis bullosa strictures. The conservative treatmentof esophageal stenosis and strictures （ES） ratherthan surgery is a well-known strategy for children.Before planning esophageal dilation, the esophagealmorphology should be assessed in detail for its length,aspect, number and level, and different conservativestrategies should be chosen accordingly. Endoscopicdilators and techniques that involve different adjuvanttreatment strategies have been reported and dependon the stricture＇s etiology, the availability of differenttools and the operator＇s experience and preferences.Balloon and semirigid dilators are the most frequentlyused tools. No high-quality studies have reported on thedifferences in the efficacies and rates of complicationsassociated with these two types of dilators. There is noconsensus in the literature regarding the frequency ofdilations or the diameter that should be achieved. Theuse of adjuvant treatments has been reported in casesof recalcitrant stenosis or strictures with evidence ofdysphagic symptoms. Corticosteroids （either systemicallyor locally injected）, the local application of mitomycin C,diathermy and laser ES sectioning have been reported.Some authors have suggested that stenting can reduceboth the number of dilations and the treatment length. Inmany cases, this strategy is effective when either metallicor plastic stents are utilized. Treatment complications,such esophageal perforations, can be conservativelymanaged, considering surgery only in cases with severepleural cavity involvement. In cases of stricture relapse,even if such relapses occur following the execution ofwell-conducted conservative strategies, surgical strictureresection and anastomosis o