Retrievable Z-Stents for the Treatment of Refractory Corrosive Esophageal Strictures in Children

Abstract

Introduction The use of retrievable esophageal stents represents a new method to avoid multiple dilations for stenosis recurrence. The aim of this study was to evaluate the efficacy of treatment with a retrievable covered Z-stent for corrosive esophageal stenosis in children.

Materials and Methods A total of 15 children were enrolled in this study. All patients had undergone balloon catheter dilatation (BCD) but without significant symptomatic improvement. A retrievable Z-stent was placed, and the dysphagia score was evaluated. After stent removal, healing was considered to have occurred if the score was 0 to 1 for at least 12 continuous months.

Results Stents were placed in all children without complications and were later removed successfully. Stents remained in situ for 4 to 8 weeks (mean, 7.4 weeks). Dysphagia scores decreased from 3 to 4 to 0 to 1 in all patients while the stent was in place. During the 12-month follow-up period, seven patients remained free from dysphagia, but eight children had recurrent stenosis and required a subsequent BCD to alleviate symptoms from the stricture. Six of them required placement of a second stent.

Conclusions The use of a retrievable Z-stent is an effective method and may become the treatment of choice for corrosive esophageal stenosis in children.

Keywords

retrievable - stent - corrosive - esophageal stenosis - children

• References

• 1 Huang YC, Ni YH, Lai HS, Chang MH. Corrosive esophagitis in children. Pediatr Surg Int 2004; 20 (3) 207-210
• 2 Weintraub JL, Eubig J. Balloon catheter dilatation of benign esophageal strictures in children. J Vasc Interv Radiol 2006; 17 (5) 831-835
• 3 Kukkady A, Pease PW. Long-term dilatation of caustic strictures of the oesophagus. Pediatr Surg Int 2002; 18 (5-6) 486-490
• 4 Youn BJ, Kim WS, Cheon JE , et al. Balloon dilatation for corrosive esophageal strictures in children: radiologic and clinical outcomes. Korean J Radiol 2010; 11 (2) 203-210
• 5 Gündoğdu HZ, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Conservative treatment of caustic esophageal strictures in children. J Pediatr Surg 1992; 27 (6) 767-770
• 6 Doo EY, Shin JH, Kim JH, Song HY. Oesophageal strictures caused by the ingestion of corrosive agents: effectiveness of balloon dilatation in children. Clin Radiol 2009; 64 (3) 265-271
• 7 Yeming W, Somme S, Chenren S, Huiming J, Ming Z, Liu DC. Balloon catheter dilatation in children with congenital and acquired esophageal anomalies. J Pediatr Surg 2002; 37 (3) 398-402
• 8 Kim JH, Song HY, Kim HC , et al. Corrosive esophageal strictures: long-term effectiveness of balloon dilation in 117 patients. J Vasc Interv Radiol 2008; 19 (5) 736-741
• 9 Cwikiel W, Willén R, Stridbeck H, Lillo-Gil R, von Holstein CS. Self-expanding stent in the treatment of benign esophageal strictures: experimental study in pigs and presentation of clinical cases. Radiology 1993; 187 (3) 667-671
• 10 Tan BS, Kennedy C, Morgan R, Owen W, Adam A. Using uncovered metallic endoprostheses to treat recurrent benign esophageal strictures. AJR Am J Roentgenol 1997; 169 (5) 1281-1284
• 11 Zhang C, Yu JM, Fan GP , et al. The use of a retrievable self-expanding stent in treating childhood benign esophageal strictures. J Pediatr Surg 2005; 40 (3) 501-504
• 12 Kramer RE, Quiros JA. Esophageal stents for severe strictures in young children: experience, benefits, and risk. Curr Gastroenterol Rep 2010; 12 (3) 203-210
• 13 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 (2) 203-206
• 14 Liu J, Hu Y, Cui C, Li Y, Lin X, Fu J. Removable, fully covered, self-expandable metal stents for the treatment of refractory benign esophagogastric anastomotic strictures. Dysphagia 2012; 27 (2) 260-264
• 15 Kim JH, Song HY, Choi EK, Kim KR, Shin JH, Lim JO. Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients. Eur Radiol 2009; 19 (2) 384-390
• 16 Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc 2005; 62 (3) 474-475
• 17 Barthel JS, Kelley ST, Klapman JB. Management of persistent gastroesophageal anastomotic strictures with removable self-expandable polyester silicon-covered (Polyflex) stents: an alternative to serial dilation. Gastrointest Endosc 2008; 67 (3) 546-552
• 18 Foschia F, De Angelis P, Torroni F , et al. Custom dynamic stent for esophageal strictures in children. J Pediatr Surg 2011; 46 (5) 848-853
• 19 Zhang C, Zhou X, Yu L, Ding J, Shi R. Endoscopic therapy in the treatment of caustic esophageal stricture: A retrospective case series study. Dig Endosc 2013; 25 (5) 490-495
• 20 Song HY, Jung HY, Park SI , et al. Covered retrievable expandable nitinol stents in patients with benign esophageal strictures: initial experience. Radiology 2000; 217 (2) 551-557
• 21 Thomas T, Abrams KR, Subramanian V, Mannath J, Ragunath K. Esophageal stents for benign refractory strictures: a meta-analysis. Endoscopy 2011; 43 (5) 386-393