Endoscopy 2009; 41: E73
DOI: 10.1055/s-0029-1214437
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

A degradable esophageal stent in the treatment of a corrosive esophageal stenosis in a child

Y.  Vandenplas1 , B.  Hauser1 , T.  Devreker1 , D.  Urbain2 , H.  Reynaert2
  • 1Unit of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel Kinderen, Brussels, Belgium
  • 2Department of Gastroenterology, Universitair Ziekenhuis Brussel, Brussels, Belgium
Further Information

Publication History

Publication Date:
24 March 2009 (online)

A 10-year-old boy accidentally ingested drain cleaner (15 % NaOH solution; pH 12.5) from a bottle. He vomited and developed dysphagia and retrosternal pain. Endoscopy showed major circumferential ulcerations (grade IIb) [1]. Follow-up endoscopy after 4 weeks showed a stenosis at the mid esophagus, allowing passage of a neonatal endoscope (diameter 4.9 mm). A self-expandable, biodegradable SX-Ella esophageal stent (diameter 25 mm, length 80 mm; Ella-CS, s. r. o., Hradec Králové, Czech Republic) was inserted 6 weeks after the ingestion with the patient under anesthesia ([Fig. 1]). Retrosternal pain, dysphagia, and nausea occurred for a few days. About 10 days later, the boy became asymptomatic. During all this time, oral omeprazole (20 mg/day) was given. Further follow-up endoscopy after 3 weeks showed that the distal end of the stent had extended into the stomach ([Fig. 2]). About 12 weeks after insertion, the stent was 50 % degraded. At that time, the esophageal mucosa had healed. Although the patient remained symptom-free for 4 months, he developed a severe distal esophageal stenosis over 4 cm about 10 months after the initial ingestion and 6 months after the stent placement.

Fig. 1 View of the stent immediately after esophageal insertion.

Fig. 2 Retrograde view of the stent protruding into the stomach after 3 weeks.

Strictures typically develop during proliferation of fibroblasts, with deposition of collagen after 1 – 3 months. Stenting, which has been performed for more than 20 years, provides a better outcome than dilation (68 % healing versus 33 %) [2] [3]. Poor patient compliance and gastroesophageal reflux resulting from esophageal shortening during scar formation were the reasons for failure [3]. In another reported series 8 out of 11 patients had a normal feeding pattern, even after stent removal (follow-up 3.5 years) [4]. Self-expanding stents are easily introduced and are removed endoscopically. Common complications of these stents are chest pain, dysphagia, and nausea [5]. Recently, biodegradable stents were developed which maintain their integrity and radial force for 6 – 8 weeks. Disintegration occurs 11 – 12 weeks after insertion. The SX-Ella esophageal degradable BD Stent should be further evaluated as first-choice intervention in patients developing a corrosive esophageal stenosis.

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References

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  • 2 Coln D, Chang J H. Experience with esophageal stenting for caustic burns in children.  J Pediatr Surg. 1986;  21 588-591
  • 3 Mutaf O. Treatment of corrosive esophageal strictures by long-term stenting.  J Pediatr Surg. 1996;  31 681-685
  • 4 Atabek C, Surer I, Demirbag S. et al . Increasing tendency in caustic esophageal burns and long-term polytetrafluroethylene stenting in severe cases: 10 years experience.  J Pediatr Surg. 2007;  42 636-640
  • 5 Holm A N, de la Mora Levy J G, Gostout C J. et al . Self-expanding plastic stents in treatment of benign esophageal conditions.  Gastrointest Endosc. 2008;  67 20-25

Y. VandenplasMD, PhD 

UZ Brussel Kinderen

Laarbeeklaan 101
1090 Brussels
Belgium

Fax: +3224775783

Email: yvan.vandenplas@uzbrussel.be