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Children Refractory Esophageal Stenosis and Its Stent Rreatment

Friday 16th March 2018 Back to list

The esophageal stenosis of children has various reasons and many treatments are adopted clinically. The common treatments include bougie dilator, balloon dilator. It is reported that 80% to 90% children could have the stenosis symptoms alleviated after endoscopic dilation. However, we still face some refractory stenosis cases, the dysphagia remains after repeated treatments. It is called refractory stenosis. Esophageal reconstruction surgery is the traditional way to treat this disease. But the open surgery has many complications such as large trauma and a great deal complications. While since we have stent implantation as an effective method to treat esophageal stenosis, we try to implant stents for children refractory stenosis diseases.

 

Our hospital have 9 cases of refractory esophageal stricture of children between May, 2009 to December 2016, (data given by Shanghai Children Hospital Digestive Department,reported in China Journal of Endoscopy ISSN:1007-1989)

 

We adopt stent implantation operation for these 9 cases and get good clinical outcomes.We make summarize of the complications after stent implantation and how we deal with these complications.

1. Thoracic pain and vomit

The stent expands to its desired diameter within 24 hours after implantation.

The corrosive esophageal stenosis has intensive nerves and it is sensitive to

pain. Children with small age has poor durability of pain. In this 9 cases, thechildren all had vomit and thoracic pain. 8 of them relieved gradually without any treatment.Only one child at the age of 4 could not bear

the pain. The stent was retrieved after 36 hours of the operation. Our

 experience is that the patient age should be above 5 years old, otherwise

the children cannot bear the pain after stent implantation. The stent size should be chosen according to individual cases. Stent at trans-cardia position should have anti-reflux valve.The child should take acid-suppression treatment. Duodenal cannula should be left to make sure nutrition supply.

 

2. 24%-37% adult patients shall have stent migration, most cases are benign esophageal stenosis. Stents at upper esophageal and lower esophageal are

easier to migrate. There are two main reasons in children cases migration:

In some cases, the inflammatory edema alleviates several days after implantation, the diameter of stent upper end becomes smaller than the esophageal

diameter; the second reason is that the esophagus above the stenosis dilates and it is fatigue in contraction. The other common reasons such as improper diet.