Factors affecting the outcome of endoscopic dilatation in refractory post-corrosive oesophageal stricture in Egyptian children: a single-centre study

Tarek, Sara; Mohsen, Nabil; El-Kareem, Dalia Abd; Hasnoon, Amera; El-Hakeem, Asmaa Abd; Eskander, Ayman

doi:10.1007/s10388-020-00727-8

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…[ 22 ] In another study including 100 children with corrosive strictures, the mean number of dilatation sessions was 37.2 ± 14.9 (16–100) and the authors concluded that endoscopic dilatation is not to be considered a failure after a limited period of time or fixed number of dilatations. [ 18 ] The maximum number of dilatations to achieve a successful result in a single patient was 50 in our series, and we agree any sort of surgical intervention must be weighed for against the risks and complications associated with surgery. Persistence with the dilatation programme outweighs the surgical alternatives in most cases.…”

Section: Discussionmentioning

confidence: 61%

“…A few authors used vertebral height as a correlation to stricture length and considered two vertebral body height as the cut-off to define a long stricture. [ 18 , 19 ] Given the age range of paediatric patients included in our study, we opted for vertebral body height to define the stricture length, and thus, one-third of the corrosive stricture patients had long strictures. However, we did not find any correlation with the length of the stricture and the parameters evaluated including the number of dilatations required for a successful outcome.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcome of endoscopic balloon dilatations employed in benign paediatric oesophageal pathologies

Durakbasa

Ersoy

Pirim

et al. 2022

Journal of Minimal Access Surgery

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Background: Oesophageal dilatations can be done either by bougies or balloons for differing aetiologies in children. We investigated the efficacy and safety of endoscopic balloon dilatations (EBDs) employed by a single surgeon. Patients and Methods: Relevant data over 12 years were retrospectively evaluated with an ethical committee approval. Results: Ninety-seven children underwent 514 EBD with a median EBD of 3 (1–50). The primary diagnoses were oesophageal atresia (OA) in 51 children, corrosive ingestion in 21, peptic strictures in 13, achalasia in 8 and congenital oesophageal stenosis in 4. The balloon size varied between 3 and 30 mm. The EBD was successfully ended in 72 patients and unsuccessful in six patients. Six children are still under EBD and 13 are lost to follow-up. The overall success rate was 92%. The age at the time of first dilatation was the youngest in OA group followed by corrosive strictures. The balloon sizes differed regarding the age of the patients with larger balloons used as the patient age increased. The sizes of the balloons used at the first and the last EBD differed among diagnostic groups. The total number of dilatations or the time interval between the first and the last EBD dilatation did not show a statistically significant difference among groups. The anatomical type of OA or the height of corrosive stricture revealed no significant difference in any of the above parameters. A transmural oesophageal perforation occurred during 2 (0.4%) EBD sessions. Conclusions: EBD is an effective mean in relieving paediatric oesophageal pathologies with a variety of aetiologies and has a low complication rate.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Clinical outcome of endoscopic balloon dilatations employed in benign paediatric oesophageal pathologies

Durakbasa

Ersoy

Pirim

et al. 2022

Journal of Minimal Access Surgery

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“…Definitely, the efficacy of dilation, the need for repeated procedures, and the risk of complication depend on the stricture severity. Length and diameter are the most critical factors associated with poorer outcomes; baseline and underlying conditions, such as long-gap EA, caustic pharyngeal involvement, gastroesophageal reflux disease, and endoscopist expertise affect the efficacy of the procedure, as highlighted in recent pediatric studies [17,18 ▪ ,19,20].…”

Section: Endoscopic Dilationsmentioning

confidence: 99%

New therapies for esophageal strictures in children

Angelino¹,

Tambucci²,

Torroni³

et al. 2021

Current Opinion in Pediatrics

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Purpose of review The present review aims at describing recent advances in therapeutic strategies for the treatment of benign esophageal strictures in children. We discuss current knowledge and practice on esophageal dilations, which are still the mainstream of treatment. We present new evidence about adjuvant treatments for recurrent and refractory strictures, including endoscopic incisional therapy, esophageal stenting, intralesional or topical mytomicin C and intralesional, systemic or topical steroids. Recent findings Current evidence on esophageal dilations is not sufficient to establish superiority of one of the available techniques, especially the use of balloon or bougie dilators, but a prospective international cohort study on anastomotic stricture in esophageal atresia is underway to address this issue. Recurrent and refractory strictures still represent a challenge, since none of the adjuvant pharmacological and mechanical interventions has shown to be enough feasible, effective and safe to revolutionize clinical practice. Summary In the last couple of years, several encouraging results have been published on management of esophageal strictures in children. Further research is needed, hopefully directed toward secure, easily reproducible and minimally invasive measures.

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“…Esophageal strictures (ES) in children cause significant morbidity, including poor nutrition and growth retardation, and may require repeated endoscopic dilations or surgical resection to relieve obstruction. 1 Caustic injury, gastroesophageal reflux disease (GERD) or eosinophilic esophagitis (EoE) are common causes of ES. 2 , 3 Ingestion of caustic substances affects several hundred children in the U. S. annually with an annual related health care expenditure of approximately twenty million dollars.…”

Section: Introductionmentioning

confidence: 99%

Acquired Esophageal Strictures in Children: Morphometric and Immunohistochemical Analyses

et al. 2021

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Background Esophageal strictures (ES) in children are not well characterized pathologically. We report unique histopathologic analyses of resected acquired ES and control esophagi (CE). Methods Muscle layer thicknesses were measured in intact well-oriented areas; inflammatory cells were counted in the most inflamed high power field (hpf). Sections were stained with relevant antibodies. Results were expressed as median, lower and upper quartiles. Wilcoxon Rank Sums non-parametric test was used to compare groups; P ≤ 0.05 was considered significant. Results All ES (N = 10) showed focal replacement of lamina propria, muscularis mucosa and submucosa by actin+ fibers emanating from muscularis propria. Compared to CE (N = 8), ES displayed significantly thickened muscularis mucosa and propria, and increased mast cells (tryptase- and chymase-positive), and eosinophils in muscle layers (all P ≤ 0.01). Matrix proteins periostin and fibronectin were identified in the muscle layers of CE, and in the extracellular matrix in areas of disrupted architecture in ES. Conclusions Compared to CE, acquired ES in children show significant structural alterations, including obliterative muscularization, inflammatory cell mural infiltrates, and extracellular matrix protein deposits. Therapies targeting connective tissue expansion, mast cells, eosinophils and inflammation may be beneficial to treat ES.

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Factors affecting the outcome of endoscopic dilatation in refractory post-corrosive oesophageal stricture in Egyptian children: a single-centre study

Cited by 4 publications

References 25 publications

Clinical outcome of endoscopic balloon dilatations employed in benign paediatric oesophageal pathologies

Clinical outcome of endoscopic balloon dilatations employed in benign paediatric oesophageal pathologies

New therapies for esophageal strictures in children

Acquired Esophageal Strictures in Children: Morphometric and Immunohistochemical Analyses

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