Tan Yuyong, Zhang Jie, Zhou Junfeng, Duan Tianying, Liu Deliang
Department of Gastroenterology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
J Pediatr Gastroenterol Nutr. 2015 Sep;61(3):319-22. doi: 10.1097/MPG.0000000000000801.
The aim of the present study was to assess the safety and efficacy of endoscopic incision (EI) for the treatment of refractory anastomotic esophageal strictures in pediatric patients.
We retrospectively reviewed the medical records of pediatric patients with refractory anastomotic strictures after surgical repair of esophageal atresia who underwent ≥3 sessions of endoscopic treatments (dilation and/or stenting). They were treated with EI alone or together with esophageal stenting. Efficacy and safety were evaluated during periodical follow-up.
All of the 7 children received the procedure successfully with the operation time of 15 to 60 minutes. Four of them received EI alone, whereas the other 3 received EI with esophageal stenting (EIES). The symptoms remitted in all of the patients, and the dysphagia score decreased from 3-4 to 0-1 during follow-up from 1 to 21 months. The average diameter of stricture was enlarged from 3 mm (range 2-5 mm) to 10.6 mm (range 8-12 mm). One patient suffered from chest pain, which resolved within 3 days. Patient 1 had recurrence 11 months after EIES, and patient 6 had recurrence 3 months after EI. They all underwent an additional EI to maintain patency. No severe complications were observed during operation and periodical follow-up.
EI is safe and appears effective for refractory esophageal anastomotic strictures in children in the short term. Large comparative studies are warranted to further confirm our findings. The long-term follow-up is necessary for assessing the long-term efficacy of the new technique.
本研究旨在评估内镜下切开术（EI）治疗小儿难治性食管吻合口狭窄的安全性和有效性。
我们回顾性分析了食管闭锁手术修复后发生难治性吻合口狭窄且接受≥3次内镜治疗（扩张和/或支架置入）的小儿患者的病历。他们单独接受EI治疗或联合食管支架置入治疗。在定期随访期间评估疗效和安全性。
7例患儿均成功接受了该手术，手术时间为15至60分钟。其中4例单独接受EI治疗，另外3例接受EI联合食管支架置入（EIES）治疗。所有患者症状均缓解，随访1至21个月期间，吞咽困难评分从3 - 4降至0 - 1。狭窄平均直径从3毫米（范围2 - 5毫米）扩大至10.6毫米（范围8 - 12毫米）。1例患者出现胸痛，3天内缓解。患者1在EIES后11个月复发，患者6在EI后3个月复发。他们均再次接受EI以维持通畅。手术及定期随访期间未观察到严重并发症。
EI治疗小儿难治性食管吻合口狭窄在短期内是安全且有效的。需要进行大型对照研究以进一步证实我们的发现。评估该新技术的长期疗效需要进行长期随访。
