Extensive caustic esophageal stricture in children can be treated by serial dilatations interspersed with silicone-covered nitinol stenting

Abstract

Recurrent esophageal stenosis secondary to caustic ingestion may be challenging to treat. Self-expandable esophageal stents may be an alternative to repetitive endoscopic esophageal dilatation. We report a case of a 2-year-old male child with an extensive esophageal caustic stricture successfully treated using a combination of endoscopic dilatation and stenting. After 5 months of serial balloon dilatations, three nitinol internal silicone covered self-expandable stents were placed through the patient’s gastrostomy spanning the entire esophagus. The stents were positioned using a combination of both endoscopic and fluoroscopic guidance. The procedure was repeated with only one stent 3 months later. A new stricture in the proximal esophagus needed surgical resection and anastomosis, followed by two pneumatic dilatations with progressively longer asymptomatic intervals. The results are promising with the patient able to use his own esophagus; however, this is a single case and optimal stent standing time is still to be determined.

Key words

Balloon dilatation - caustic ingestion - esophageal stenosis - self-expandable stents

• References

• 1 Contini S, Swarray-Deen A, Scarpignato C. Oesophageal corrosive injuries in children: A forgotten social and health challenge in developing countries. Bull World Health Organ 2009;87:950-4.
• 2 Michaud L, Gottrand F. Anastomotic strictures: Conservative treatment. J Pediatr Gastroenterol Nutr 2011;52 Suppl 1:S18-9.
• 3 Siersema PD, de Wijkerslooth LR. Dilation of refractory benign esophageal strictures. Gastrointest Endosc 2009;70:1000-12.
• 4 Lévesque D, Baird R, Laberge JM. Refractory strictures post-esophageal atresia repair: What are the alternatives? Dis Esophagus 2013;26:382-7.
• 5 Broto J, Gil-Vernet JM, Royo G, Cabañas MJ. Use of mitomycin C in esophageal stenosis. Cir Pediatr 2007;20:57-8.
• 6 Foschia F, De Angelis P, Torroni F, Romeo E, Caldaro T, di Abriola GF, et al. Custom dynamic stent for esophageal strictures in children. J Pediatr Surg 2011;46:848-53.
• 7 Rico FR, Panzer AM, Kooros K, Rossi TM, Pegoli W Jr. Use of Polyflex Airway stent in the treatment of perforated esophageal stricture in an infant: A case report. J Pediatr Surg 2007;42:E5-8.
• 8 Broto J, Asensio M, Vernet JM. Results of a new technique in the treatment of severe esophageal stenosis in children: Poliflex stents. J Pediatr Gastroenterol Nutr 2003;37:203-6.
• 9 Hindy P, Hong J, Lam-Tsai Y, Gress F. A comprehensive review of esophageal stents. Gastroenterol Hepatol (N Y) 2012;8:526-34.