Menard-Katcher Calies, Furuta Glenn T, Kramer Robert E
*Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado †Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO ‡Gastrointestinal Eosinophilic Diseases Program §Mucosal Inflammation Program.
J Pediatr Gastroenterol Nutr. 2017 May;64(5):701-706. doi: 10.1097/MPG.0000000000001336.
Although several studies report on the experience with adult eosinophilic esophagitis (EoE)-related stricture, outcomes for pediatric patients with EoE-associated fibrostenosis and stricture is more limited. To address this, we aim to identify the adverse event (AE) rate and short-term outcomes of the largest reported cohort of children with EoE to undergo esophageal dilation for management of symptomatic esophageal narrowing.
A retrospective assessment of all children, 18 years and younger, who underwent esophageal dilation at an academic children's hospital during a 5-year period was conducted. Clinical, endoscopic, histologic, and outcomes of dilation were extracted from the medical record. AEs were captured within a standardized endoscopic AE database. Grade 2 AEs (requiring unanticipated medical intervention) were termed significant. Dilation-related events were compared between patients with EoE, without EoE, and those undergoing standard upper endoscopy.
Of the 451 total dilations, 68 dilations were performed in 40 EoE patients (mean age 13.8 years, standard deviation 3.3 years [4.6-18.9 years]). Forty-three percent (17/40) had repeat dilation during the study period. Dilation-related grade 2 AE rates in EoE and in non-EoE patients were 2.9% and 3.1%, respectively (P > 0.5). Chest pain (any grade AE) was reported in 14.7% of EoE dilations. No significant associations were found between postprocedural pain and dilation method, final dilator size, medical therapy, or esophageal eosinophilia. No perforations or significant hemorrhage were reported.
We conclude that dilation can be performed safely in children with EoE. In the appropriate clinical setting, cautious dilation may be considered in the management of fibrostenotic EoE.
尽管有多项研究报告了成人嗜酸性粒细胞性食管炎（EoE）相关狭窄的治疗经验，但关于小儿EoE相关纤维狭窄和狭窄的治疗结果的报道较为有限。为了解决这一问题，我们旨在确定接受食管扩张术治疗有症状食管狭窄的最大规模已报道EoE儿童队列的不良事件（AE）发生率和短期治疗结果。
对一家学术儿童医院在5年期间接受食管扩张术的所有18岁及以下儿童进行回顾性评估。从病历中提取临床、内镜、组织学和扩张治疗结果。不良事件记录在标准化的内镜不良事件数据库中。2级不良事件（需要意外的医疗干预）被定义为严重不良事件。对EoE患者、非EoE患者以及接受标准上消化道内镜检查的患者之间的扩张相关事件进行比较。
在总共451次扩张中，40例EoE患者（平均年龄13.8岁，标准差3.3岁[4.6 - 18.9岁]）进行了68次扩张。43%（17/40）的患者在研究期间进行了重复扩张。EoE患者和非EoE患者的扩张相关2级不良事件发生率分别为2.9%和3.1%（P>0.5）。14.7%的EoE扩张患者报告有胸痛（任何级别的不良事件）。术后疼痛与扩张方法、最终扩张器尺寸、药物治疗或食管嗜酸性粒细胞增多之间未发现显著关联。未报告穿孔或严重出血。
我们得出结论，EoE患儿可以安全地进行扩张术。在适当的临床情况下，对于纤维狭窄性EoE的治疗可考虑谨慎扩张。
