Department of Pediatric Surgery, Heidelberg University, Theodor-Kutzer-Ufer, Mannheim, Germany.
Central Interdisciplinary Endoscopy, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer, Mannheim, Germany.
Dis Esophagus. 2018 Nov 1;31(11). doi: 10.1093/dote/doy061.
There is a lack of experience with fully covered self-expandable metal stents (SEMSs) for the treatment of benign esophageal conditions in the pediatric population. This is the evaluation of our institutional experience of placing SEMSs for anastomotic stricture (AS) formation following esophageal atresia (EA) repair. Patients were jointly managed from the Department of Pediatric Surgery and Central Interdisciplinary Endoscopy at our institution. Thirteen children (8 male, 5 female) with a median age of 4 months (range: 1-32 months) who underwent treatment with SEMSs for a postoperative AS following EA repair between February 2006 and April 2016 were recruited into this retrospective study. SEMSs that are originally designed for other organs such as trachea, bronchus, biliary tract, or colon were inserted under general anesthesia via endoscopic guidance. Simultaneous fluoroscopy was not required in any case. In five infants, the stents were inserted primarily without previous therapy. Seven patients underwent stenting following dilatation with or without adjuncts (e.g. Mitomycin C, Triamcinolone). In one case with an AS and a simultaneous persistent tracheoesophageal fistula (TEF), multiple SEMSs were applied after failure to close the fistula with fibrin glue.The median duration of individual stent placement was 30 days (range: 5-91 days). In five children up to four different biliary, bronchial or colonic SEMSs were placed successively over time. There were no problems noted at stent insertion or removal. Eight children (62%) developed complications associated with stenting. At follow-up, in eight patients (62%) AS was resolved, including all of those five cases, who had their stents inserted without previous therapy. Five children (38%), who underwent dilatation prior to stenting did not improve their AS and required further intervention. Overall, the cohort exhibited a slight, but not significant weight gain between stent insertion and (final) stent removal.Insertion of SEMSs for AS following EA repair is safe and often successful with only one single application. It can be used as a primary procedure (without previous therapy) or after failed dilatations.There was one death in this study that was unrelated to stenting and occurred 12 months after stent removal. Because of the absence of manufactured, age-related devices, SEMSs that are originally designed for other organs can be applied. Establishment of a standardized management including stent placement for the treatment of AS following EA repair in the pediatric population is required.
在儿科人群中，完全覆膜自膨式金属支架（SEMS）治疗良性食管疾病的经验有限。这是我们机构在治疗食管闭锁（EA）修复后吻合口狭窄（AS）形成中放置 SEMS 的经验评估。患者由我们机构的小儿外科和中央内镜介入科联合管理。2006 年 2 月至 2016 年 4 月期间，13 名儿童（8 名男性，5 名女性）因 EA 修复后出现术后 AS 而行 SEMS 治疗，纳入本回顾性研究。在全身麻醉下，通过内镜引导插入最初设计用于气管、支气管、胆道或结肠等其他器官的 SEMS。在任何情况下都不需要同时进行透视。在 5 名婴儿中，支架是在没有先前治疗的情况下直接插入的。7 名患者在扩张后进行支架置入，扩张可辅以或不辅以（如丝裂霉素 C、曲安奈德）。在一例 AS 合并持续性气管食管瘘（TEF）的患者中，在使用纤维蛋白胶关闭瘘管失败后，应用了多个 SEMS。单个支架放置的中位时间为 30 天（范围：5-91 天）。5 名儿童中，随着时间的推移，先后成功放置了 5 个不同的胆道、支气管或结肠 SEMS。支架置入和取出时均无问题。8 名儿童（62%）出现与支架相关的并发症。随访时，8 名儿童（62%）的 AS 得到缓解，包括 5 名未接受先前治疗的儿童。5 名在支架置入前接受扩张的儿童 AS 未得到改善，需要进一步干预。总体而言，支架置入和（最终）支架取出之间，患儿的体重略有增加，但无统计学意义。EA 修复后 AS 采用 SEMS 治疗是安全的，且往往是成功的，仅需单次应用。它可以作为主要治疗方法（无需先前治疗），或在扩张失败后使用。本研究中有 1 例死亡，与支架无关，发生在支架取出后 12 个月。由于缺乏针对特定年龄的制造设备，因此可以应用最初设计用于其他器官的 SEMS。需要制定标准化管理方案，包括在儿科人群中采用支架置入治疗 EA 修复后的 AS。
