Tratamento das estenoses esofágicas por dilatação endoscópica em crianças e adolescentes

Abstract

Objective: To assess the causes of esophageal stricture in pediatric patients and their response to endoscopic dilatation.Methods: Retrospective analysis of clinical and endoscopic data obtained from children and adolescents with esophageal stricture submitted to endoscopic dilatation between July 1993 and January 2003.Results: A total of 125 patients aged between 1 month and 16 years were included in the study. Among the types of stenosis, postoperative (43.2%), corrosive (27.2%) and peptic (21.6%) strictures were the most prevalent. Those patients with corrosive esophageal stricture needed more dilatation sessions. Five cases of esophageal perforation and one case of hemorrhage occurred due to complications during the procedure. Good response to endoscopic treatment was described in 74.4% of cases, but better results were obtained from patients with peptic esophageal stricture.Conclusions: Endoscopic treatment of esophageal strictures in children and adolescents yields good results and has a low rate of complications. Corrosive esophageal strictures have a higher morbidity and require more dilatation sessions.

An audit of the management of oesophageal stricture in children in Durban, KwaZulu-Natal Province, South Africa

“…Resolution of dysphagia is considered the most relevant parameter but the potential weakness of this endpoint is that many patients with refractory stenosis report significantly improved symptoms shortly after dilatation, but they gradually worsen over time. [7,9] In our study, HIV-infected patients did poorly, compared with those who were either negative or not tested for HIV. All HIV-infected patients who died had established AIDS with a low CD4 count.…”

“…Postoperative morbidity now accounts for a significant proportion of the burden of the disease, and despite the recent refinements of operative techniques and improvements in perioperative management, anastomotic stricture after repair of oesophageal atresia remains frequent and develops in nearly 40% of operated patients. [7][8][9][10] Improved survival has increased the number of children with oesophageal anastomotic strictures referred for treatment, and they now account for 35.9% of patients with OSs in our unit. Strictures secondary to the surgical correction of oesophageal atresia often show a good response to endoscopic treatment augmented by an anti-reflux procedure.…”

“…Early diagnosis is the most important prognostic factor to reduce morbidity and mortality, which is reported to range between 0% and 33%. [7,29] There are several parameters that have been used to describe the outcome of patients suffering from OSs. Resolution of dysphagia is considered the most relevant parameter but the potential weakness of this endpoint is that many patients with refractory stenosis report significantly improved symptoms shortly after dilatation, but they gradually worsen over time.…”

“…An adequate lumen should be re-established within 6 months to 1 year, with progressively longer intervals between dilatations. [3,7,31] If, during the course of treatment, an adequate lumen cannot be established or maintained, more aggressive intervention should be considered.…”

Comparative Analysis of Adverse Events After Esophageal Balloon and Bougie Dilations in Children

“…Bougie dilators apply both axial and radial force to the entire esophagus as they are inserted through the mouth and advanced into the stomach, whereas balloon dilators apply only radial force and can be applied to more focal stricture sites with direct visualization of the balloon placement with or without fluoroscopic guidance. Studies on adverse events (AEs) related to esophageal dilation in children have often focused on perforation and have varying results (0–2% with balloon dilation) (1–5) (0–0.9% with bougie) (6,7). These studies have not directly compared both methods.…”