Gugig Roberto, Muñoz Jurado Guillermo, Huang Clifton, Oleas Roberto, Robles-Medranda Carlos
University of California San Francisco and Valley Children's Healthcare, San Francisco, California, United States.
Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil, Ecuador.
Endosc Int Open. 2018 Jan;6(1):E64-E66. doi: 10.1055/s-0043-118745. Epub 2018 Jan 16.
Childhood achalasia treatment remains inconclusive. What is next after myotomy failure? Repeated pneumatic-dilation put patients at greater risk of perforation with possible symptom recurrence. We report on a 12-year-old patient with a 1-year history of achalasia whom underwent Heller myotomy with fundoplication and recurred with symptoms 1 week after surgery. Pneumatic dilatation was considered but not done because of the risk of esophageal perforation. The decision was made to place a fully covered self-expanding metallic stent (FC-SEMS) for 3 months, which resolved the stenosis as confirmed by esophagram. The patient has remained asymptomatic since the procedure was performed 2 years ago. FC-SEMS is an alternative for treatment of refractory achalasia in children who do not respond to conventional treatment.
儿童贲门失弛缓症的治疗仍无定论。肌切开术失败后下一步该怎么做？反复进行气囊扩张会使患者面临更大的穿孔风险，且症状可能复发。我们报告一例12岁贲门失弛缓症患者，有1年病史，接受了贲门肌层切开术加胃底折叠术，术后1周症状复发。考虑过进行气囊扩张，但由于存在食管穿孔风险而未实施。决定放置一个全覆膜自膨式金属支架（FC-SEMS）3个月，食管造影证实狭窄已解除。自2年前实施该手术后，患者一直无症状。FC-SEMS是治疗对传统治疗无反应的儿童难治性贲门失弛缓症的一种替代方法。
