Bawazir Osama, Almaimani Mohammed O
Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia. E-mail.
Saudi Med J. 2020 Jul;41(7):720-725. doi: 10.15537/smj.2020.7.25166.
To report the results of endoscopic dilatation of esophageal strictures in children, its complications, and their management. The outcomes of esophageal dilatation differ according to the underlying etiology.
The study included 46 patients who underwent esophageal dilatation between 2014-2019. All patients underwent a contrast study of the esophagus before endoscopic dilation to determine the location, number, and length of the narrowing. In addition, the type of dilators (balloon versus semi-rigid dilators), the number of dilatation sessions, the interval between them, and the duration of follow-up were also documented. The median age was 2.47 years, and 26 patients were females. Dysphagia was the main presenting symptom, and the leading cause of stricture was esophageal atresia.
The main treatment modality was endoscopic balloon dilatation (n=29, 63%). The esophageal diameter was significantly increased after dilation (9 [7-11] versus 12 [10-12.8]) mm; p less than 0.001). Topical mitomycin-C was used as adjuvant therapy in 3 patients (6.5%). Esophageal perforation was reported in 2 cases (4.3%). Patients needed a median of 3 dilatation sessions, 25-75th percentiles: 1-5, and the median duration between the first and last dilatation was 2.18 years 25-75th percentiles: 0.5-4.21.
Esophageal dilatation is effective for the management of children with esophageal stricture; however, repeated dilatation is frequent, especially in patients with corrosive strictures. Complications are not common, and open surgery is not frequently required.
报告儿童食管狭窄内镜扩张的结果、并发症及其处理。食管扩张的结果因潜在病因不同而有所差异。
本研究纳入了2014年至2019年间接受食管扩张的46例患者。所有患者在进行内镜扩张前均接受了食管造影检查，以确定狭窄的位置、数量和长度。此外，还记录了扩张器的类型（球囊扩张器与半刚性扩张器）、扩张次数、两次扩张之间的间隔以及随访时间。中位年龄为2.47岁，女性患者26例。吞咽困难是主要的临床表现，狭窄的主要原因是食管闭锁。
主要治疗方式为内镜下球囊扩张（n = 29，63%）。扩张后食管直径显著增加（9 [7 - 11] 对 12 [10 - 12.8]）mm；p < 0.001）。3例患者（6.5%）使用丝裂霉素C局部治疗作为辅助治疗。报告了2例食管穿孔（4.3%）。患者平均需要3次扩张，第25至75百分位数为：1 - 5次，第一次和最后一次扩张之间的中位时间为2.18年，第25至75百分位数为：0.5 - 4.21年。
食管扩张对儿童食管狭窄的治疗有效；然而，反复扩张很常见，尤其是在腐蚀性狭窄患者中。并发症并不常见，通常不需要进行开放手术。
