Imondi C, Bartoli ME, Torroni F, Faraci S, Caldaro T, De Angelis P, Balassone V. Innovative endoscopic alternatives for the conservative management of recurrent/refractory esophageal strictures in children: A case series. World J Gastrointest Endosc 2025; 17(8): 104238 [DOI: 10.4253/wjge.v17.i8.104238]
Corresponding Author of This Article
Valerio Balassone, MD, PhD, Department of Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Lazio, Italy. valerio.balassone@opbg.net
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Aug 16, 2025; 17(8): 104238 Published online Aug 16, 2025. doi: 10.4253/wjge.v17.i8.104238
Innovative endoscopic alternatives for the conservative management of recurrent/refractory esophageal strictures in children: A case series
Chiara Imondi, Maria Elisabetta Bartoli, Filippo Torroni, Simona Faraci, Tamara Caldaro, Paola De Angelis, Valerio Balassone
Chiara Imondi, Filippo Torroni, Simona Faraci, Tamara Caldaro, Paola De Angelis, Valerio Balassone, Department of Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Rome 00165, Lazio, Italy
Maria Elisabetta Bartoli, Department of Pediatric Surgery Academy, Tor Vergata University of Rome, Rome 00165, Lazio, Italy
Author contributions: Imondi C, Bartoli ME, and Balassone V designed the study, performed the literature review and structured the report; Imondi C, Torroni F, Faraci S, Caldaro T, and De Angelis P performed the procedures described in the clinical cases; Torroni F, Faraci S, Caldaro T, and De Angelis P participated in the literature review and revised the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Bambino Gesù Children’s Hospital, approval No. 2817_OPBG_2025.
Informed consent statement: Complete written informed consent has been obtained from the involved patients’ parents for unlabeled treatments.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All published data are proprieties of Bambino Gesù Children’s Hospital IRCCS-Rome.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Valerio Balassone, MD, PhD, Department of Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Piazza Sant’Onofrio 4, Rome 00165, Lazio, Italy. valerio.balassone@opbg.net
Received: December 25, 2024 Revised: March 26, 2025 Accepted: July 2, 2025 Published online: August 16, 2025 Processing time: 237 Days and 9.4 Hours
Abstract
BACKGROUND
Refractory esophageal strictures (ES) are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval. Recurrent ES (REES) refer to the inability to maintain a satisfactory luminal diameter for four weeks once an age-appropriate feeding diameter was achieved. Seriated endoscopic dilations are the reference maintenance for ES in pediatric age. Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems. Furthermore, fibrotic modifications can make the surgery even more challenging. The surgical approach is burdened by high morbidity, with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.
AIM
To evaluate the efficacy and safety of the most recent adjuvant treatments, with the aim of avoiding or, at least, postponing surgery.
METHODS
Intralesional steroids or mitomycin C injections with antiproliferative and anti-fibroblastic properties have been attempted, but have been abandoned because of systemic adsorption, local complications, or lack of efficacy. Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications, in terms of stent migration, local pain and perforation. Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall, but it requires an appropriate diameter for placement.
RESULTS
Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space. Re-absorbable self-expanding stents (like SX-ELLA Stent Esophageal Degradable BD-BD stent) and energy-delivering surgical devices (HARMONIC ACE™ + 7 Laparoscope) have also been proposed.
CONCLUSION
After an overview about the historically applied adjuvant therapies, we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases, focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or, at least, postponing an invasive replacement surgery.
Core Tip: The management of refractory and recurrent esophageal strictures is particularly challenging in pediatric age. Reiterative endoscopic dilations and replacement surgery are the standard treatment but burdened by high procedural risks and non-negligible economic and social costs. Several adjuvant strategies have proven inadequate as real alternatives to surgery. Here we report our experience with the most innovative adjuvant techniques for the treatment of recurrent esophageal strictures, focusing on their medium-term efficacy and safety, with the aim of avoiding or, at least, postponing invasive replacement surgery, until patients’ greater clinical stability and better nutritional status is achieved.
