van Hal Annefleur R L, Pulvirenti Rebecca, den Hartog Floris P J, Vlot John
Department of Pediatric Surgery and Intensive Care, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands.
Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
Front Pediatr. 2022 Jan 28;9:825030. doi: 10.3389/fped.2021.825030. eCollection 2021.
Intralesional steroid injections (ISI) are a widely used technique for various pediatric indications and represent a possible adjuvant treatment for anastomotic esophageal strictures. Yet, no consensus has been reached neither on their safety in the pediatric population or their effectiveness in esophageal atresia patients. This systematic review aimed to assess the safety of ISI in young children through a meta-analysis and to summarize the current knowledge on the effectiveness of ISI in anastomotic esophageal strictures.
A systematic literature search was performed in Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Google Scholar up to August 16 2021. Studies focusing on ISI and involving children up to 2 years were included in the meta-analysis for the safety assessment. All studies evaluating the use of ISI as adjuvant treatment in anastomotic esophageal strictures in children were included in the systematic review to assess the effectiveness of the intervention.
The literature search yielded 8,253 articles. A total of 57 studies were included, of which 55 for the safety and five for the effectiveness assessment. The overall complication rate was 7%, with a greater incidence of local complications compared to systemic complications. Six studies (with a total of 367 patients) evaluated adrenocorticotropic hormone and cortisol levels, of which four reported hypothalamic-pituitary axis suppression. Two children (0.6%) received replacement therapy and all patients recovered uneventfully. A mean number of 1.67 ISI were performed per esophageal atresia (EA) patient. A reduction of needed dilatations was seen after ISI, compared to the number of dilatations performed before the intervention (5.2 vs. 1.3).
The insufficient data emphasized the need for further prospective and comparative studies. Results from this meta-analysis and systematic review address ISI as a safe and effective technique. Close clinical follow-up and growth curve evaluation are advisable in patients receiving ISI.
PROSPERO, identifier: CRD42021281584.
病灶内注射类固醇（ISI）是一种广泛应用于多种儿科适应症的技术，也是吻合口食管狭窄可能的辅助治疗方法。然而，对于其在儿科人群中的安全性以及在食管闭锁患者中的有效性，尚未达成共识。本系统评价旨在通过荟萃分析评估ISI在幼儿中的安全性，并总结当前关于ISI在吻合口食管狭窄有效性的知识。
截至2021年8月16日，在Embase、Medline、科学网核心合集、Cochrane对照试验中心注册库和谷歌学术上进行了系统的文献检索。纳入荟萃分析以评估安全性的研究聚焦于ISI且涉及2岁以下儿童。所有评估ISI作为儿童吻合口食管狭窄辅助治疗应用的研究均纳入系统评价，以评估该干预措施的有效性。
文献检索共获得8253篇文章。总共纳入了57项研究，其中55项用于安全性评估，5项用于有效性评估。总体并发症发生率为7%，局部并发症的发生率高于全身并发症。六项研究（共367例患者）评估了促肾上腺皮质激素和皮质醇水平，其中四项报告了下丘脑 - 垂体轴抑制。两名儿童（0.6%）接受了替代治疗，所有患者均顺利康复。每名食管闭锁（EA）患者平均进行1.67次ISI。与干预前进行的扩张次数相比，ISI后所需扩张次数减少（5.2次对1.3次）。
数据不足强调了进一步进行前瞻性和对比研究的必要性。该荟萃分析和系统评价的结果表明ISI是一种安全有效的技术。建议对接受ISI的患者进行密切的临床随访和生长曲线评估。
PROSPERO，标识符：CRD42021281584。
