Geng Lanlan, Liang Cuiping, Yang Min, Chen Peiyu, Ou Wenji, Liu Wei, Gong Sitang
Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou 510120, China.
Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou 510120, China. Email:
Zhonghua Er Ke Za Zhi. 2014 May;52(5):333-8.
To evaluate the efficacy of endoscopic balloon dilatation, stenting and surgery in treating corrosive esophageal stricture of children.
We retrospectively analyzed the management of 31 children who were treated with endoscopic balloon dilatation, stenting or gastric tube esophagoplasty because of corrosive esophageal stricture between August 2005 and December 2012. Dysphagia was graded into 4 grades according to Stooler grading methods. The efficacy was divided into 3 grades which were very effective, effective and ineffective according to the improvement of dysphagia.
Among 31 children with corrosive esophageal stricture, in 22 children the problem was caused by alkali, in 9 by acid; 23 children had long-segment stricture and 8 had short-segment stricture. The number (rates) of cases in whom the endoscopic balloon dilatation was very effective, effective, and ineffective were 12 (38.7%) , 7 (22.6%) , 12 (38.7%) , respectively. The number of cases in whom stenting was effective or ineffective was 1 and 3, respectively. The gastric tube esophagoplasty was very effective and effective in 8 and 2 cases, respectively. Total rates of very effective, effective, and ineffective of 3 treatments were 64.5%, 29%, 6.5% respectively. The efficacy of endoscopic balloon dilatation was better in short-segment stricture and bigger caliber stricture, the efficacy was not so good for other types of strictures. The efficacy of balloon dilatation was not related with the nature of substances (either alkaline or acidic). Compared with very effective group, the ineffective group with longer course of disease before dilatation (t = -2.091, P = 0.048) , smaller stricture calibre (t = 2.855, P = 0.009) , longer stricture segment (t = -3.405, P = 0.003) and longer dilatation time (t = -2.103, P = 0.047) , had statistical significance.
Endoscopic balloon dilatation was the preferred treatment for corrosive esophageal stricture of children. The efficacy was better in shorter course of disease, short-segment stricture and bigger caliber stricture, for other situations the efficacy was not so good. The efficacy of balloon dilatation was not related with the nature of substances.Stent or surgery can be considered if efficacy of balloon dilatation was not so good.Gastric tube esophagoplasty is an effective treatment for complicated corrosive esophageal stricture.
评估内镜下球囊扩张、支架置入及手术治疗儿童腐蚀性食管狭窄的疗效。
回顾性分析2005年8月至2012年12月间因腐蚀性食管狭窄接受内镜下球囊扩张、支架置入或胃管食管成形术治疗的31例儿童的治疗情况。吞咽困难根据Stooler分级法分为4级。根据吞咽困难的改善情况，疗效分为非常有效、有效和无效3级。
31例腐蚀性食管狭窄儿童中，22例由碱性物质所致，9例由酸性物质所致；23例为长段狭窄，8例为短段狭窄。内镜下球囊扩张非常有效、有效和无效的病例数（率）分别为12例（38.7%）、7例（22.6%）、12例（38.7%）。支架置入有效和无效的病例数分别为1例和3例。胃管食管成形术非常有效和有效的病例数分别为8例和2例。3种治疗方法的非常有效、有效和无效的总发生率分别为64.5%、29%、6.5%。内镜下球囊扩张在短段狭窄和较大口径狭窄中的疗效较好，对其他类型狭窄的疗效欠佳。球囊扩张的疗效与物质性质（碱性或酸性）无关。与非常有效组相比，无效组扩张前病程较长（t = -2.091，P = 0.048）、狭窄口径较小（t = 2.855，P = 0.009）、狭窄段较长（t = -3.405，P = 0.003）及扩张时间较长（t = -2.103，P = 0.047），差异有统计学意义。
内镜下球囊扩张是儿童腐蚀性食管狭窄的首选治疗方法。病程较短、短段狭窄及较大口径狭窄时疗效较好，其他情况疗效欠佳。球囊扩张的疗效与物质性质无关。球囊扩张疗效欠佳时可考虑支架置入或手术治疗。胃管食管成形术是治疗复杂性腐蚀性食管狭窄的有效方法。
