Efficacy and risk profile of self-expandable stents in the management of pediatric esophageal pathology

Experience with Fully Covered Self-Expandable Metal Stents for Esophageal Leakage in Children

“…Although SEMSs seem to offer some advantages in the management of esophageal injuries in adults [1,3] the use of SEMSs for esophageal leakage and/or perforation in children is still being discussed in the literature [4,7,24]. In this context, nonoperative treatment has been postulated as the first therapeutic choice [12,13,20,21], whereas stenting is considered as an alternative option in cases, in which conservative therapy failed [4,7,19,23,24]. This study focuses solely on stent placement for post-interventional leakage of the esophagus in children including premature infants.…”

“…In contrast, in a recent study on the efficacy and risk profile of SEMSs in 13 children of which most suffered from esophageal strictures all devices were only administered as a penultimate treatment strategy prior to definitive operative repair. Although the outcome was poor with a 100 % recurrence rate for strictures the au- thors conceded a positive effect regarding the role of SEMSs as a bridge to operative repair particularly in children with major esophageal perforations [7]. We regard a conservative management (i. e. with pleural and mediastinal drainage) of a leakage or perforation as a suboptimal approach resulting in a more or less distinctive inflammation of the esophageal wall.…”

“…Stent migration is a well-known complication occurring between 12-56 % in pediatric series [4,7,17,19,24]. Of note, these are associated more frequently with plastic devices [19].…”

“…Of note, these are associated more frequently with plastic devices [19]. Therefore, some authors postulate close radiological monitoring during stenting [4,7,19]. In this series, the stent position was documented only once following insertion in order to minimize radiation exposure.…”

“…In adults endoscopy with stent placement has been advocated as a minimally invasive procedure to preserve the patient's esophagus [8,11,15,22,26,28]. Most recently, the use of fully covered self-expandable metal stents (SEMSs) has been reported with different outcome for benign esophageal disorders in children [2,4,7,17,19,24]. SEMSs are inserted via a delivery system, which facilitates placement and reduces the incidence of trauma and perforation during insertion [25].…”