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Wang XY, Chen HY, Sun Q, Li MH, Xu MN, Sun T, Huang ZH, Zhao DL, Li BR, Ning SB, Fan CX. Global trends and research hotspots in esophageal strictures: A bibliometric study. World J Gastrointest Surg 2025; 17:100920. [PMID: 40162389 PMCID: PMC11948135 DOI: 10.4240/wjgs.v17.i3.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 12/31/2024] [Accepted: 01/21/2025] [Indexed: 02/24/2025] Open
Abstract
BACKGROUND Esophageal stricture is a prevalent condition affecting the digestive system, primarily marked by dysphagia and the obstruction of food passage through the esophagus. This narrowing of the esophageal lumen can significantly impact a person's ability to eat and drink comfortably, often leading to a decrease in nutritional intake and quality of life. AIM To explore the current research status and future trends of esophageal stricture through bibliometric analysis. METHODS Literature on esophageal stricture from 2004 to 2023 was retrieved from the Web of Science Core Collection. Statistical analysis was performed using Excel, VOSviewer, CiteSpace, and RStudio. This study provides data on annual production trends, countries/regions, influential authors, institutions, journals, references, and keywords. RESULTS The study included 1485 publications written by 7469 authors from 1692 institutions across 66 countries/regions, published in 417 journals. The United States, China, and Japan are the major contributors to this field, with many quality papers. Song Ho-young, Diseases of the Esophagus, Gastrointestinal Endoscopy, and Mayo Clinic are the top authors, journals, co-cited journals, and institutions, respectively. The most frequent keywords are stent, endoscopy, management, etiology, and prevention; regenerative medicine, endoscopic injection, and autologous tissue transplantation are the latest research frontiers. These keywords reflect continuous advancements in technical innovation, treatment strategies, preventive measures in the esophageal stricture research field, and a sustained focus on improving patient prognosis. In contrast, the basic sciences were underrepresented. CONCLUSION This study provides an insightful analysis of the developments in the field of esophageal stricture over the past twenty years, with stent placement is currently a hot research topic.
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Affiliation(s)
- Xiao-Ying Wang
- College of Life Science, Northwest University, Xi’an 710069, Shaanxi Province, China
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Hong-Yu Chen
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
- The Air Force Clinical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Qi Sun
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Man-Hua Li
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Meng-Nan Xu
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Tao Sun
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Zi-Han Huang
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Dong-Lin Zhao
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Bai-Rong Li
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Shou-Bin Ning
- College of Life Science, Northwest University, Xi’an 710069, Shaanxi Province, China
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Chong-Xi Fan
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
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Shah A, Sharma R, Shah A. Double Trouble: A Rare Case of Dual Esophageal Stenosis in a 4-month-old. J Indian Assoc Pediatr Surg 2024; 29:654-656. [PMID: 39691922 PMCID: PMC11649056 DOI: 10.4103/jiaps.jiaps_145_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 12/19/2024] Open
Abstract
Esophageal stenosis is an uncommon clinical condition defined as a fixed narrowing of the esophagus. It can be congenital or acquired. The incidence of congenital esophageal stenosis (CES) is 1 in 25,000-50,000 live births. Most of these patients present in early infancy and many of them require surgical intervention. We report a very interesting case of a 4-month-old child with esophageal stenosis involving two different segments of the esophagus who was successfully treated surgically. This is one of the rarest variants of CES which involves two different segments of the esophagus.
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Affiliation(s)
- Amar Shah
- Neonatal and Pediatric Surgeon, Amardeep Multispecialty Children Hospital and Research Centre, Ahmedabad, Gujarat, India
| | - Ria Sharma
- Neonatal and Pediatric Surgeon, Amardeep Multispecialty Children Hospital and Research Centre, Ahmedabad, Gujarat, India
| | - Anirudh Shah
- Neonatal and Pediatric Surgeon, Amardeep Multispecialty Children Hospital and Research Centre, Ahmedabad, Gujarat, India
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Marques Dos Santos F, Afonso I, Soares E, Carneiro R. Chondroepithelial Choristoma: A Rare Cause of Congenital Esophageal Stenosis. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:217-220. [PMID: 38836126 PMCID: PMC11149987 DOI: 10.1159/000534081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/25/2023] [Indexed: 06/06/2024]
Affiliation(s)
| | - Isabel Afonso
- Hospital Dona Estefânia - Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Eugénia Soares
- Hospital Dona Estefânia - Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Rita Carneiro
- Hospital Dona Estefânia - Centro Hospitalar Lisboa Central, Lisboa, Portugal
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Fujiwara Y, Kitagami H, Kikkawa T, Sakashita K, Kusumi T, Nishida Y. Esophageal cancer in an adult with congenital esophageal stenosis: a case report. Surg Case Rep 2024; 10:58. [PMID: 38467897 PMCID: PMC10928053 DOI: 10.1186/s40792-024-01858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Congenital esophageal stenosis (CES) is a rare condition. We encountered a case of esophageal cancer that developed in an adult with persistent CES. Although many studies have investigated the therapeutic outcomes and performed surveillance for symptoms after treatment for CES, few have performed long-term surveillance or reported on the development of esophageal cancer. We report this case because it is extremely rare and has important implications. CASE PRESENTATION A 45-year-old woman with worsening dysphagia was transferred to our hospital. The patient was diagnosed with CES at 5 years of age and underwent surgery at another hospital. The patient underwent esophageal dilatation for stenosis at 36 years of age. Esophagoscopy performed at our hospital revealed a circumferential ulcerated lesion and stenosis 15-29 cm from the incisors. Histological examination of the biopsy specimen revealed squamous cell carcinoma. Computed tomography (CT) revealed abnormal circumferential wall thickening in parts of the cervical and almost the entire thoracic esophagus. 18F-fluorodeoxyglucose-positron emission tomography-CT revealed increased uptake in the cervical and upper esophagus. No uptake was observed in the muscular layers of the middle or lower esophagus. Based on these findings, the patient was diagnosed with clinical stage IVB cervical and upper esophageal cancer (T3N1M1 [supraclavicular lymph nodes]). The patient underwent a total esophagectomy after neoadjuvant chemotherapy. The esophagus was markedly thickened and tightly adhered to the adjacent organs. Severe fibrosis was observed around the trachea. Marked thickening of the muscular layer was observed throughout the esophagus; histopathological examination revealed that this thickening was due to increased smooth muscle mass. No cartilage, bronchial epithelium, or glands were observed. The carcinoma extended from the cervical to the middle esophagus, oral to the stenotic region. Finally, we diagnosed the patient with esophageal cancer developing on CES of the fibromuscular thickening type. CONCLUSIONS Chronic mechanical and chemical irritations are believed to cause cancer of the upper esophagus oral to a persistent CES, suggesting the need for long-term surveillance that focuses on residual stenosis and cancer development in patients with CES.
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Affiliation(s)
- Yushi Fujiwara
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan.
| | - Hidehiko Kitagami
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Tomohiro Kikkawa
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Keita Sakashita
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Takaya Kusumi
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Yasunori Nishida
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
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5
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Pirzirenli MG, Büyükkarabacak Y. Surgical esophageal diseases in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S108-S118. [PMID: 38584792 PMCID: PMC10995682 DOI: 10.5606/tgkdc.dergisi.2024.25770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 04/09/2024]
Abstract
Pediatric age esophageal diseases are rare and complex clinical conditions. Treatment options should be individually determined for the patient. The advances in the follow-up and treatment process is the most important reason for the increase in survival time, particularly for congenital pediatric surgical diseases. This study aimed to evaluate the general characteristics of pediatric surgical esophageal diseases in light of the literature.
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Affiliation(s)
| | - Yasemin Büyükkarabacak
- Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
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Hohl B, Hoskins B, Ng K. A Child with an Esophageal Web Treated with Functional Lumen Imaging Probe. JPGN REPORTS 2023; 4:e304. [PMID: 37200730 PMCID: PMC10187835 DOI: 10.1097/pg9.0000000000000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/07/2023] [Indexed: 05/20/2023]
Abstract
A 14-month-old male presented to the emergency department with a 4-day history of vomiting after the intake of liquids or solids. During the admission, imaging studies revealed an esophageal web, a form of congenital esophageal stenosis. He was treated with a combination of Endoluminal Functional Lumen Imaging Probe (EndoFLIP) and controlled radial expansion (CRE) balloon dilation, followed by EndoFLIP and EsoFLIP dilation 1 month later. The patient's vomiting resolved after treatment, and he was able to gain weight. This report describes one of the first cases of applying EndoFLIP and EsoFLIP to treat an esophageal web in a pediatric patient.
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Affiliation(s)
- Brenna Hohl
- From the Department of Medicine, Campbell University School of Osteopathic Medicine, Lillington, NC
| | - Brett Hoskins
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenneth Ng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
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Yasuda JL, Manfredi MA. Endoscopic Management of Congenital Esophageal Defects and Associated Comorbidities. Gastrointest Endosc Clin N Am 2023; 33:341-361. [PMID: 36948750 DOI: 10.1016/j.giec.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The endoscopist plays a critical role in the management of patients with congenital esophageal defects. This review focuses on esophageal atresia and congenital esophageal strictures and, in particular, the endoscopic management of comorbidities related to these conditions, including anastomotic strictures, tracheoesophageal fistulas, esophageal perforations, and esophagitis surveillance. Practical aspects of endoscopic techniques for stricture management are reviewed including dilation, intralesional steroid injection, stenting, and endoscopic incisional therapy. Endoscopic surveillance for mucosal pathology is essential in this population, as patients are at high risk of esophagitis and its late complications such as Barrett's esophagus.
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Affiliation(s)
- Jessica L Yasuda
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Michael A Manfredi
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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8
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Shalvey E, Guzmán P, Hoey S, Cuq B. Congenital esophageal stenosis in a Labrador retriever. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2022; 63:1213-1216. [PMID: 36467380 PMCID: PMC9648477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
A 1-year-old neutered male Labrador retriever was presented for investigation of chronic regurgitations that had started at weaning. Contrast radiographs and fluoroscopy of the thorax identified a focal narrowing of the proximal intrathoracic esophagus. Examination with CT-angiography excluded extraluminal causes for the narrowing, e.g., vascular ring anomaly. Esophagoscopy revealed the presence of a muscular stenosis with the appearance of a sphincter at the level of the proximal intrathoracic esophagus, without evidence of stricture. A diagnosis of congenital esophageal stenosis was made, suspected secondary to fibromuscular hypertrophy. Regurgitation resolved with conservative management and the dog was well at a 2-year follow-up examination. This case represents one of few small animal cases of congenital esophageal stenosis reported and apparently the only case successfully managed conservatively. Key clinical message: This report describes the clinical presentation, diagnostic imaging findings, and treatment of a rare case of congenital esophageal stenosis in a Labrador retriever. Medical and conservative therapies alone may be sufficient for treatment of congenital esophageal stenosis depending on presentation and suspected histopathological type. These therapies should be considered before initiating interventional procedures.
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9
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Liu SQ, Lv Y, Luo RX. Endoscopic magnetic compression stricturoplasty for congenital esophageal stenosis: A case report. World J Clin Cases 2022; 10:12313-12318. [PMID: 36483808 PMCID: PMC9724527 DOI: 10.12998/wjcc.v10.i33.12313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/24/2022] [Accepted: 10/17/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Congenital esophageal stenosis (CES) is a rare malformation of the digestive tract. Endoscopic dilation and thoracotomy have been the main treatments for CES. However, there is no well-defined management protocol. Magnetic compression stricturoplasty (MCS) has been used in refractory esophageal stricture in children after esophageal atresia. CASE SUMMARY We describe the first case of MCS for CES in one female child patient. The child (aged 3 years and 1 mo) was admitted due to frequent vomiting and choking after eating complementary food since 7 mo old. Esophagography and gastroendoscopy showed that there was stenosis in the lower esophagus, suggesting a diagnosis of CES. The patient did not receive any treatment for esophageal stricture including surgery or endoscopic dilation procedures before MCS. MCS procedure was smoothly conducted without complications. At 24 mo after MCS, durable esophageal patency without dysphagia was achieved. CONCLUSION MCS may serve as an alternative and efficient method for patients with CES.
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Affiliation(s)
- Shi-Qi Liu
- Department of Nursing, The Medical College, Xijing University, Xi’an 710123, Shaanxi Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Rui-Xue Luo
- The Corrosion & Protection Research Lab, Northwest Institute for Nonferrous Metal Research, Xi’an 710016, Shaanxi Province, China
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Gao Z, Wang L, Liu H, Zhang X. Congenital esophageal stenosis caused by tracheobronchial remnants: a case report. J Int Med Res 2022; 50:3000605221132704. [PMID: 36271607 PMCID: PMC9597040 DOI: 10.1177/03000605221132704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a case of congenital esophageal stenosis in which the patient underwent ineffective balloon dilatation twice and eventually required surgery. The case was initially misdiagnosed as achalasia. Pathological findings revealed tracheobronchial remnants (TBRs) in the muscular layer of strictured esophageal tissue. Most TBR strictures are located in the middle and lower thirds of the esophagus. Esophagography is the main examination method for esophageal stricture, and the appearance of the "rat tail sign" is a key diagnostic indicator. Endoscopic ultrasonography can reveal hypoechoic cartilaginous structures. The gold standards for TBR treatment include esophageal stricture resection, end-to-end esophageal anastomosis, and the construction of structures to prevent reflux. At present, endoscopic longitudinal resection and transverse anastomosis of the anterior esophageal wall with partial cartilage resection without pyloroplasty are novel and practical TBR procedures. To avoid further complications, patients with congenital esophageal stenosis should be promptly treated surgically if balloon dilatation is ineffective.
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Affiliation(s)
- Zhihong Gao
- Health Management Center, The Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
| | - Lingyan Wang
- Department of Pathology, Hebei Children’s Hospital,
Shijiazhuang, Hebei, China
| | - Huaijun Liu
- Department of Radiology, The Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
| | - Xia Zhang
- Department of Radiology, Hebei Children’s Hospital,
Shijiazhuang, Hebei, China,Xia Zhang, No. 133, Jianhua South Street,
Yuhua District, Shijiazhuang City, Hebei Province, 050031, P. R. China.
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11
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Management and clinical outcomes of congenital esophageal stenosis in pediatric patients: Experience of a tertiary referral center. J Pediatr Surg 2022; 57:518-525. [PMID: 34229876 DOI: 10.1016/j.jpedsurg.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to retrospectively investigate congenital esophageal stenosis (CES) cases managed at our institution using a non-aggressive strategy based on a step-up approach from esophageal balloon dilatations to surgery. METHODS Patients' charts with CES managed in a tertiary pediatric surgery department were retrospectively evaluated. Demographic characteristics, clinical features, pH-monitoring, imaging, and esophagoscopy results were recorded together with their treatments and outcomes. RESULTS Nineteen patients, confirmed with radiologic and endoscopic investigations, were managed. Complete symptom resolution was achieved in 14 patients by a median of five (2-15) recurrent esophageal balloon dilatations lasting for 7.5 (2-108) months. Two more patients, after 7 and 15 dilatations, had mild dysphagia, not interfering with their daily living. One patient, in whom the initial dilatation attempt with 3 atm was unsuccessful, and two patients with persistent symptoms and growth retardation despite ongoing dilatation treatment, underwent surgery. After 48 (12-132) months of follow-up, 17 patients were symptom-free. CONCLUSION Conservative treatment with esophageal balloon dilatations is an efficient and reliable modality that can be used as a first-line treatment in CES. Surgical treatment option should be used when dilatation attempt is unsuccessful, or symptoms and growth retardation persist despite dilatation treatment.
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12
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Braungart S, Peters RT, Lansdale N, Wilkinson DJ. Congenital oesophageal stenosis in oesophageal atresia: underrecognised and often missed? Pediatr Surg Int 2022; 38:331-335. [PMID: 34741643 DOI: 10.1007/s00383-021-05036-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Congenital oesophageal stenosis (COS) is characterised by an intrinsic oesophageal narrowing that is present, but not necessarily symptomatic at birth. Small studies report an association of COS with oesophageal atresia (OA) in up to 14% of OA cases. Although OA is usually appreciated shortly after birth, the diagnosis of a concomitant COS is frequently delayed. This risk may be increased with the current movement away from routine postoperative upper gastrointestinal (GI) contrast study following OA repair. We performed a systematic review of the literature to assess the timing of diagnosis of COS in patients with COS and OA and how this impacted on patient outcomes. METHODS A systematic review in accordance with PRISMA guidelines was undertaken. Only patients with OA associated with COS were included. Delayed diagnosis was defined as presentation > 1 month of age. RESULTS 14 full-text studies with a total of 131 patients were included. Diagnosis of COS was delayed in 62/131 (47%) patients. These children presented with symptoms of dysphagia and aspiration at a median age of 13.5 months (IQR 7-30 months). In total, 18/131 patients were identified at the initial operation, due to difficulty passing a tube distally into the stomach. The data on timing of contrast studies were provided in 60/131 (46%) patients. A routine postoperative contrast study was performed in 39/60 (65%) of these, of which COS was identified immediately in 28/39 (72%). A diagnosis of COS could also be made on retrospective review of the early contrast study in a further 6/39 patients, giving an overall sensitivity of 87%. CONCLUSION The association of COS and OA may be underrecognised and diagnosis delayed if routine contrast study is not performed. Contrast studies, performed in the neonatal period are effective at detecting a concomitant COS (sensitivity > 87%). This review supports routine early contrast study after OA repair with specific consideration of the presence of COS.
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Affiliation(s)
- Sarah Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M139WL, UK
| | - Robert Thomas Peters
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M139WL, UK
| | - Nick Lansdale
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M139WL, UK.,Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - David John Wilkinson
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M139WL, UK.
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13
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Ludwig K, De Bartolo D, Salerno A, Ingravallo G, Cazzato G, Giacometti C, Dall’Igna P. Congenital anomalies of the tubular gastrointestinal tract. Pathologica 2022; 114:40-54. [PMID: 35212315 PMCID: PMC9040549 DOI: 10.32074/1591-951x-553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 02/08/2023] Open
Abstract
Congenital anomalies of the tubular gastrointestinal tract are an important cause of morbidity not only in infants, but also in children and adults. The gastrointestinal (GI) tract, composed of all three primitive germ layers, develops early during embryogenesis. Two major steps in its development are the formation of the gut tube (giving rise to the foregut, the midgut and the hindgut), and the formation of individual organs with specialized cell types. Formation of an intact and functioning GI tract is under strict control from various molecular pathways. Disruption of any of these crucial mechanisms involved in the cell-fate decision along the dorsoventral, anteroposterior, left-right and radial axes, can lead to numerous congenital anomalies, most of which occur and present in infancy. However, they may run undetected during childhood. Therapy is surgical, which in some cases must be performed urgently, and prognosis depends on early diagnosis and suitable treatment. A precise pathologic macroscopic or microscopic diagnosis is important, not only for the immediate treatment and management of affected individuals, but also for future counselling of the affected individual and their family. This is even more true in cases of multiple anomalies or syndromic patterns. We discuss some of the more frequent or clinically important congenital anomalies of the tubular GI, including atresia's, duplications, intestinal malrotation, Meckel's diverticulum and Hirschsprung's Disease.
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Affiliation(s)
- Katrhin Ludwig
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Debora De Bartolo
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Angela Salerno
- Department of Oncology, Anatomic and Histologic Pathology and Cytodiagnostics, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ingravallo
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Gerardo Cazzato
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Cinzia Giacometti
- Department of Services, Pathology Unit, ULSS 6 “Euganea”, Camposampiero, Italy
| | - Patrizia Dall’Igna
- Department of Emergencies and Organ Transplantation, Pediatric Surgery, University of Bari, Bari, Italy
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14
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G Fachin C, G Oliveira G, A Becker K, M Citon J, A Coelho T, I B Dos Santos A. Thoracoscopy Approach in Prone Position for Esophagoplasty in Children. J Laparoendosc Adv Surg Tech A 2021; 31:1445-1448. [PMID: 34748414 DOI: 10.1089/lap.2021.0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Congenital esophageal stenosis (CES) is a very rare clinical condition found in 1 per 25,000 to 50,000 live births. There are three histological types of CES described: tracheobronchial remnants, fibromuscular stenosis (FMS), and membranous stenosis. The first-line treatment in most cases is the conservative treatment (dilatation with a Savary bougie or balloon), but in some CES types, dilatation may be ineffective or result in esophageal perforation with serious complications or lethal outcome. Resection of the stenotic segment and end-to-end esophageal anastomosis was formerly presented as the most common surgical treatment option for CES. However, esophagoplasty is a safe and feasible alternative for surgical treatment of esophageal stenosis in children. Our aim is to report two cases of FMS submitted to thoracoscopic esophagoplasty. Both cases started with dysphagia and refusal after transition to solid diet, at 6 months old, and the radiological examination showed stricture of the distal esophagus. Esophagoplasty was performed with the patients in prone position. The stenotic esophageal wall was incised longitudinally and transverse synthesis was performed. After surgery, the patients had prompt recovery, without recurrent stenosis, remaining asymptomatic, with good diet acceptance.
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Affiliation(s)
- Camila G Fachin
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Gustavo G Oliveira
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Karin A Becker
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Júlia M Citon
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Tatiane A Coelho
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - André I B Dos Santos
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
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Mochizuki K, Yokoi A, Urushihara N, Yabe K, Nakashima H, Kitagawa N, Maeda K, Fukumoto K, Shinkai M. Characteristics and treatment of congenital esophageal stenosis: A retrospective collaborative study from three Japanese children's hospitals. J Pediatr Surg 2021; 56:1771-1775. [PMID: 33455805 DOI: 10.1016/j.jpedsurg.2020.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/26/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND/PURPOSE There is no consensus on treatment strategy of congenital esophageal stenosis (CES). This study aimed to assess appropriateness of the treatment we have provided to patients with CES over the past four decades. METHODS We carried out a retrospective chart review of 83 CES patients treated at three children's hospitals between 1973 and 2015. Each patient underwent an initial treatment with either surgery or a series of dilation that was followed by surgery if dilation failed to improve esophageal transit. Demographic data, course of treatment, outcomes, and complications were analyzed. RESULTS During this initial treatment, 19 and 64 patients underwent surgery and dilation, respectively. Out of the 64 patients who underwent dilations as an initial treatment, 26 patients eventually required surgery. Out of all patients who required surgery (19 initial treatments + 26 failed dilations), 29 had tracheobronchial remnants and 16 had fibromuscular hypertrophy. Six patients experienced esophageal perforation during dilation and ten experienced anastomotic leakage after surgery. No patients had swallowing difficulties at the latest follow up, 141(9-324) months. CONCLUSIONS Dilation is recommended as an initial therapy, especially if histological diagnosis of CES is uncertain. Persistent swallowing difficulties after 2 series of dilation may be an indication for surgery. LEVELS OF EVIDENCE level IV.
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Affiliation(s)
- Kyoko Mochizuki
- Department of Surgery, Kanagawa Children's Medical Center(,) Yokohama, Japan.
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kiyoaki Yabe
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Hideaki Nakashima
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Norihiko Kitagawa
- Department of Surgery, Kanagawa Children's Medical Center(,) Yokohama, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Kouji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masato Shinkai
- Department of Surgery, Kanagawa Children's Medical Center(,) Yokohama, Japan
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16
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Taylor J, Ikeri K, Cardona VQ. Case 3: Case of a Drooling Infant. Neoreviews 2021; 22:e58-e60. [PMID: 33386316 DOI: 10.1542/neo.22-1-e58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Kelechi Ikeri
- Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA
| | - Vilmaris Quinones Cardona
- Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA.,Drexel University College of Medicine, Philadelphia, PA
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17
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Ritz LA, Hajji MS, Schwerd T, Koletzko S, von Schweinitz D, Lurz E, Hubertus J. Esophageal Perforation and EVAC in Pediatric Patients: A Case Series of Four Children. Front Pediatr 2021; 9:727472. [PMID: 34458215 PMCID: PMC8386293 DOI: 10.3389/fped.2021.727472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: In pediatric patients, esophageal perforation (EP) is rare but associated with significant morbidity and mortality rates of up to 20-30%. In addition to standard treatment options, endoscopic esophageal vacuum-assisted closure (EVAC) therapy has shown promising results, especially in adult patients. Thus far, the only data on technical success and effectiveness of EVAC in pediatric patients were published in 2018 by Manfredi et al. at Boston Children's Hospital. The sparse data on EVAC in children indicates that this promising technique has been barely utilized in pediatric patients. More data are needed to evaluate efficacy and outcomes of this technique in pediatric patients. Method: We reviewed five cases of therapy using EVAC, ArgyleTM Replogle Suction Catheter (RSC), or both on pediatric patients with EP in our institution between October 2018 and April 2020. Results: Five patients with EP (median 3.4 years; 2 males) were treated with EVAC, RSC, or a combination. Complete closure of EP was not achieved after EVAC alone, though patients' health stabilized and inflammation and size of EP decreased after EVAC. Four patients then were treated with RSC until the EP healed. One patient needed surgery as the recurrent fistula did not heal sufficiently after 3 weeks of EVAC therapy. Two patients developed stenosis and were successfully treated with dilatations. One patient treated with RSC alone showed persistent EP after 5 weeks. Conclusion: EVAC in pediatric patients is technically feasible and a promising method to treat EP, regardless of the underlying cause. EVAC therapy can be terminated as soon as local inflammation and C-reactive protein levels decrease, even if the mucosa is not healed completely at that time. A promising subsequent treatment is RSC. An earlier switch to RSC can substantially reduce the need of anesthesia during subsequent treatments. Our findings indicate that EVAC is more effective than RSC alone. In some cases, EVAC can be used to improve the tissues condition in preparation for a re-do surgery. At 1 year after therapy, all but one patient demonstrated sufficient weight gain. Further prospective studies with a larger cohort are required to confirm our observations from this small case series.
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Affiliation(s)
- Laura Antonia Ritz
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Mohammad Samer Hajji
- Department of Pediatric Gastroenterology, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Tobias Schwerd
- Department of Pediatric Gastroenterology, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Sibylle Koletzko
- Department of Pediatric Gastroenterology, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Eberhard Lurz
- Department of Pediatric Gastroenterology, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
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18
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Yasuda JL, Staffa SJ, Clark SJ, Ngo PD, Zendejas B, Hamilton TE, Jennings RW, Manfredi MA. Endoscopic incisional therapy and other novel strategies for effective treatment of congenital esophageal stenosis. J Pediatr Surg 2020; 55:2342-2347. [PMID: 32057439 DOI: 10.1016/j.jpedsurg.2020.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/12/2019] [Accepted: 01/04/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND & AIMS Congenital esophageal stenosis (CES) is an inborn condition of the esophagus that can be refractory to endoscopic dilation. Surgical intervention is not curative, with patients experiencing frequent ongoing need for therapy for anastomotic stricture postoperatively. We hypothesized that novel methods of endoscopic CES management including endoscopic incisional therapy (EIT) would lead to less surgical intervention. METHODS We retrospectively reviewed the medical records of all patients with CES treated by our tertiary care center who had at least one endoscopy between July 2007 and July 2019. Statistical comparison of cohorts who underwent advanced endoscopic therapy involving EIT versus traditional endoscopic therapy with balloon dilation was performed. Primary outcome measure was need for surgical intervention. RESULTS Thirty-six patients with CES met inclusion criteria. Thirty-four ever had at least one endoscopic intervention such as balloon dilation, steroid injection, stenting, and/or endoscopic incisional therapy (EIT) at their CES. Esophageal vacuum assisted closure (EVAC) was used for treatment or prevention of esophageal leak. Odds of surgical intervention were significantly lower in the group who received therapeutic endoscopy with EIT (odds ratio (OR) 0.1; p = 0.007). Clinical feeding outcomes were similar in the endoscopic and surgical management groups. Odds of complications after therapeutic endoscopies involving EIT were significantly greater than those without EIT (odds ratio 6.39; 95% confidence interval (2.34, 17.44); p < 0.001), though our rates of esophageal leak significantly decreased over time as our use of EVAC increased (Spearman's ρ = -0.884; p = 0.004). CONCLUSION Complementary endoscopic techniques such as EIT broaden the toolbox of the treating physician and may allow for avoidance of surgery in CES. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jessica L Yasuda
- Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital, Boston, MA, United States.
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Susannah J Clark
- Department of General Surgery; Boston Children's Hospital, Boston, MA, United States
| | - Peter D Ngo
- Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital, Boston, MA, United States
| | - Benjamin Zendejas
- Department of General Surgery; Boston Children's Hospital, Boston, MA, United States
| | - Thomas E Hamilton
- Department of General Surgery; Boston Children's Hospital, Boston, MA, United States
| | - Russell W Jennings
- Department of General Surgery; Boston Children's Hospital, Boston, MA, United States
| | - Michael A Manfredi
- Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital, Boston, MA, United States
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Mochizuki K, Shinkai M, Kitagawa N, Usui H. Laparoscopic partial circular myectomy for congenital esophageal stenosis due to tracheobronchial remnant. Asian J Endosc Surg 2020; 13:592-595. [PMID: 31965730 DOI: 10.1111/ases.12786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 01/05/2020] [Indexed: 11/27/2022]
Abstract
Congenital esophageal stenosis (CES) is a rare anomaly, and its appropriate management is not well established. This may be the first report describing laparoscopic partial circular myectomy of the esophageal wall in an infant with CES caused by tracheobronchial remnant (TBR). The narrow segment of the esophagus was laparoscopically detected 1 cm above the esophagogastric junction because the segment was whiter and narrower than the other parts of the esophagus. The narrow segment was approximately 1.5 cm in length. Partial anterior 270° circular muscle layers were dissected using hook electrocautery. Small cartilage-like tissues were identified during the procedure. The muscular layers of both ends were interruptedly sutured. Intraoperative complications were not detected. After undergoing balloon dilation for slight residual stenosis, the patient could eat solid foods without vomiting. Laparoscopic partial circular myectomy is safe and effective for short-segment lower esophageal stenosis in patients with CES caused by TBR.
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Affiliation(s)
- Kyoko Mochizuki
- Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Masato Shinkai
- Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Norihiko Kitagawa
- Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hidehito Usui
- Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
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20
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Ulukaya Durakbasa C, Kiyan G, Aydoner S, Pirim A, Seneldir H, Ozkok S, Caymaz I. Epiphrenic Diverticulum in an Infant with Congenital Esophageal Stenosis Associated with Esophageal Atresia. Medeni Med J 2020; 35:261-265. [PMID: 33110679 PMCID: PMC7584271 DOI: 10.5222/mmj.2020.22220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022] Open
Abstract
Congenital esophageal stenosis (CES) is a rare congenital disorder which may be isolated or associated with esophageal atresia (EA). It courses with esophageal outflow tract obstruction. Esophageal epiphrenic diverticulae are esophageal outpouchings above diaphragm which develop because of an underlying esophageal motor disorder. We present an infant who had CES associated with EA detected during the course of routine follow-up. She underwent several sessions of esophageal balloon dilatations for CES with some symptomatic improvement. However, an epiphrenic diverticulum (ED) developed during the course of treatment which was detected by further investigations. A surgical excision was performed with a successful outcome. An ED developed secondary to CES has not been previously reported. We have highlighted the diagnostic modalities employed, treatment options, and clinical follow-up for these two rare conditions in children.
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Affiliation(s)
- Cigdem Ulukaya Durakbasa
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Gursu Kiyan
- Marmara University Faculty of Medicine, Pendik Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Sinem Aydoner
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Ahmet Pirim
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Hatice Seneldir
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Pathology, Istanbul, Turkey
| | - Sercin Ozkok
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Ismail Caymaz
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Radiology, Istanbul, Turkey
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21
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Conighi ML, Bleve C, Costa L, Chiarenza SF. Congenital esophageal stenosis associated with esophageal atresia: A novel treatment. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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22
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Multiple Congenital Esophageal Stenoses in a 15-Month-old Child. J Pediatr Gastroenterol Nutr 2020; 71:e97. [PMID: 32404751 DOI: 10.1097/mpg.0000000000002766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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23
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Brzački V, Mladenović B, Jeremić L, Živanović D, Govedarović N, Dimić D, Golubović M, Stoičkov V. Congenital esophageal stenosis: a rare malformation of the foregut. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:535-547. [PMID: 31849372 PMCID: PMC6892676 DOI: 10.18999/nagjms.81.4.535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/17/2019] [Indexed: 12/30/2022]
Abstract
Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological subtypes (tracheobronchial remnants, fibromuscular thickening or fibromuscular stenosis, and membranous webbing or esophageal membrane) are described. Symptoms of CES usually appears with the introduction of the semisolid alimentation. Dysphagia is the most common symptom, but esophageal food impaction, respiratory distress or failure to thrive can be clinical manifestations of CES. Wide spectrum of differential diagnoses leads to delayed definitive diagnosis and appropriate treatment. Depends on hystological subtype of CES, some treatment procedures (dilation or segmental esophageal resection) are recommended, but individually approach is still important in terms of frequency and type of dilation procedures or type of the surgical treatment. Dysphagia can persist after the treatment and a long follow-up period is recommended. In 33% of patients with CES, a different malformations in the digestive system, but also in the other systems, are described.
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Affiliation(s)
- Vesna Brzački
- Gastroenterology and Hepatology Clinic, Clinical Center Niš, Niš, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Bojan Mladenović
- Gastroenterology and Hepatology Clinic, Clinical Center Niš, Niš, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Ljiljana Jeremić
- General Surgery Clinic, Clinical Center Niš, Niš, Serbia
- Department of Surgery, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Dragoljub Živanović
- Department of Surgery, Faculty of Medicine, University of Niš, Niš, Serbia
- Pediatric Surgery and Orthopedic Clinic, Clinical Center Niš, Niš, Serbia
| | - Nenad Govedarović
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Hematology and Clinical Immunology Clinic, Clinical Center Niš, Niš, Serbia
| | - Dragan Dimić
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Endocrinology Clinic, Clinical Center Niš, Niš, Serbia
| | - Mladjan Golubović
- Anesthesiology and Reanimation Center, Clinical Center Niš, Niš, Serbia
| | - Viktor Stoičkov
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Institute for Treatment and Rehabilitation "Niška Banja," Niš, Serbia
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24
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Shirota C, Tanaka Y, Tainaka T, Sumida W, Yokota K, Makita S, Oshima K, Tanaka T, Tani Y, Uchida H. Therapeutic strategy for thoracoscopic repair of esophageal atresia and its outcome. Pediatr Surg Int 2019; 35:1071-1076. [PMID: 31399810 DOI: 10.1007/s00383-019-04541-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Thoracoscopic repair can be safely performed in most types of congenital esophageal atresia (EA), including in patients with long gap EA or very low birth weight. Accordingly, we performed single- or multistage thoracoscopic repair for various EA types. We aimed to report our therapeutic strategy for thoracoscopic radical surgery for treating EA and its outcome. METHODS Outcomes of radical surgeries for treating congenital EA at our institute from 2013 to 2018 were retrospectively evaluated. RESULTS Thirty-eight radical surgeries were evaluated: 3 Gross type-A, 1 type-B, 30 type-C, 1 type-D, and 3 type-E. The cervical approach was performed in 5 cases and thoracoscopic esophageal anastomosis in 33, including 26 single-stage (all type-C) and 7 multistage surgeries (3 type-A, 3 type-C, and 1 type-D). There were no cases of thoracotomies or intraoperative thoracoscopic surgery complications. Three cases of minor leakage were conservatively resolved. Three postoperative chylothorax surgeries (9%) and seven balloon dilatations (21%) for anastomotic stenosis were performed. CONCLUSION Thoracoscopic radical surgery for treating EA, including single- and multistage procedures, can be performed, except in type-E cases or when the end of the proximal esophagus is located higher than the clavicle.
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Affiliation(s)
- Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuo Oshima
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukiko Tani
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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25
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Di Lorenzo C, Kaj B, Krishnan K, Moran CJ, Goldstein AM, Gee MS, Masia R. Case 29-2019: A 14-Month-Old Boy with Vomiting. N Engl J Med 2019; 381:1159-1167. [PMID: 31532965 DOI: 10.1056/nejmcpc1904049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Carlo Di Lorenzo
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Batul Kaj
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Kumar Krishnan
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Christopher J Moran
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Allan M Goldstein
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Michael S Gee
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Ricard Masia
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
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McEvoy LCS, Ottino LJ, Ricca RL. Robotic-Assisted Thoracoscopic Esophageal Myotomy as Effective Treatment for Congenital Esophageal Stenosis. Am Surg 2019. [DOI: 10.1177/000313481908500612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Robert L. Ricca
- Department of Surgery Naval Medical Center Portsmouth Portsmouth, Virginia
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27
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Bellon M, Skhiri A, Julien-Marsollier F, Malbezin S, Thierno D, Hilly J, ElGhoneimi A, Bonnard A, Michelet D, Dahmani S. Paediatric minimally invasive abdominal and urological surgeries: Current trends and perioperative management. Anaesth Crit Care Pain Med 2018; 37:453-457. [DOI: 10.1016/j.accpm.2017.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/14/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022]
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Abstract
PURPOSE OF REVIEW Guidelines were recently published highlighting why esophageal atresia (EA) patients are prone to complication risks, and the need for long-term follow-up. In this review, we will focus on how to investigate and treat potential complications, as well as the pros and cons of different investigative and treatment modalities, and what areas continue to need further research. RECENT FINDINGS EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.
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29
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Suzuhigashi M, Kaji T, Noguchi H, Muto M, Goto M, Mukai M, Nakame K, Kawano T, Yamada W, Yamada K, Onishi S, Ieiri S. Current characteristics and management of congenital esophageal stenosis: 40 consecutive cases from a multicenter study in the Kyushu area of Japan. Pediatr Surg Int 2017; 33:1035-1040. [PMID: 28801834 DOI: 10.1007/s00383-017-4133-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Congenital esophageal stenosis (CES) is rare, and the available clinical data are limited. We explored the current diagnosis, treatment and outcomes of CES. METHODS A questionnaire survey was performed using medical records at pediatric surgical centers in the Kyushu area. RESULTS Over 10 years, 40 patients (24 males) had CES. The incidence of associated anomalies was 52.5% (21/40), and that of esophageal atresia was 20.0% (8/40). The mean age at the diagnosis was 12.0 months (range, 1 day-8.8 years). Seven (17.5%) patients were diagnosed in the neonatal period. Ten (25.0%) developed CES due to tracheobronchial remnants, 27 (67.5%) due to fibromuscular stenosis (FMS) and 1 (2.5%) due to membranous stenosis + FMS. Thirty-six (90.0%) were treated by balloon dilatation (mean, 3 times; range, 1-20). Perforation at dilatation occurred in 7 (17.5%) patients, and all were diagnosed with FMS. Eighteen (45.0%) patients underwent radical operation (3 primary, 15 secondary to dilatation). CONCLUSIONS Our study clarified the characteristics and outcomes of CES, including neonatal diagnoses. CES occurred in 1 in every 33,000 births in the Kyushu area. Careful attention should be paid, even in cases of dilatation for FMS. CES requires long-term follow-up for symptom persistence after adequate and repeated treatment.
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Affiliation(s)
- Masaya Suzuhigashi
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan.,Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hiroyuki Noguchi
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Michiko Goto
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Motoi Mukai
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kazuhiko Nakame
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
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Lees MC, Dicken BJ. Congenital esophageal stenosis in 3 children: A case series. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kim SH, Kim HY, Jung SE, Lee SC, Park KW. Clinical Study of Congenital Esophageal Stenosis: Comparison according to Association of Esophageal Atresia and Tracheoesophageal Fistula. Pediatr Gastroenterol Hepatol Nutr 2017; 20:79-86. [PMID: 28730131 PMCID: PMC5517383 DOI: 10.5223/pghn.2017.20.2.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Congenital esophageal atresia (CES) is a rare congenital disease. The severity of symptoms is variable; thus, diagnosis is difficult and tends to be delayed. CES is frequently accompanied by esophageal atresia (EA) with/without tracheoesophageal fistula (TEF). We investigated the characteristics of CES by reviewing our experience with CES patients and researched the differences between CES with EA-TEF and isolated CES. METHODS A total of 31 patients underwent operations for CES were reviewed retrospectively. The patients were divided into two groups according to the association with EA-TEF, and compared the differences. RESULTS Sixteen boys and 15 girls were included. The mean age at symptom onset was 8 months old, and the mean age at diagnosis was 21 months old. Nine patients with EA-TEF were included group A, whereas the other 22 patients were assigned to group B. There were no differences in sex, gestational age, associated anomalies and pathologic results between the groups. In group A, the age at diagnosis and age at surgery were younger than in group B despite the age at symptom occurrence being similar. Postoperative complications occurred only in group A. CONCLUSION In this study, symptoms occurred during the weaning period, and vomiting was the most frequent symptom. CES patients with EA-TEF tended to be diagnosed and treated earlier despite the age at symptom occurrence being similar. CES patients with EA-TEF had more postoperative complications; therefore, greater attention should be paid during the postoperative period.
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Affiliation(s)
- Soo-Hong Kim
- Department of Pediatric Surgery, Pusan National University Children's Hospital, Yangsan, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Seong-Cheol Lee
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Kwi-Won Park
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
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Abstract
Esophageal duplication and congenital esophageal stenosis (CES) may represent diseases with common embryologic etiologies, namely, faulty tracheoesophageal separation and differentiation. Here, we will re-enforce definitions for these diseases as well as review their embryology, diagnosis, and treatment.
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Affiliation(s)
- A Francois Trappey
- David Grant Medical Center, Travis Air Force Base, California; Division of Trauma, Acute Care Surgery, and Surgical Critical Care, UC Davis Medical Center, Sacramento, California
| | - Shinjiro Hirose
- Department of Surgery, UC Davis Medical Center, Sacramento, California; Division of Pediatric General, Thoracic, and Fetal Surgery, UC Davis Medical Center, Sacramento, California; Shriners Hospitals for Children-Northern California, 2425 Stockton Blvd, Sacramento, California 95817.
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ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula. J Pediatr Gastroenterol Nutr 2016; 63:550-570. [PMID: 27579697 DOI: 10.1097/mpg.0000000000001401] [Citation(s) in RCA: 240] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is one of the most common congenital digestive anomalies. With improvements in surgical techniques and intensive care treatments, the focus of care of these patients has shifted from mortality to morbidity and quality-of-life issues. These children face gastrointestinal (GI) problems not only in early childhood but also through adolescence and adulthood. There is, however, currently a lack of a systematic approach to the care of these patients. The GI working group of International Network on Esophageal Atresia comprises members from ESPGHAN/NASPGHAN and was charged with the task of developing uniform evidence-based guidelines for the management of GI complications in children with EA. METHODS Thirty-six clinical questions addressing the diagnosis, treatment, and prognosis of the common GI complications in patients with EA were formulated. Questions on the diagnosis, and treatment of gastroesophageal reflux, management of "cyanotic spells," etiology, investigation and management of dysphagia, feeding difficulties, anastomotic strictures, congenital esophageal stenosis in EA patients were addressed. The importance of excluding eosinophilic esophagitis and associated GI anomalies in symptomatic patients with EA is discussed as is the quality of life of these patients and the importance of a systematic transition of care to adulthood. A systematic literature search was performed from inception to March 2014 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation.
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Yokota K, Uchida H, Tanano A, Shirota C, Tainaka T, Hinoki A, Murase N, Oshima K, Shirotsuki R, Chiba K. Steroid pulse therapy prevents restenosis following balloon dilatation for esophageal stricture. Pediatr Surg Int 2016; 32:875-879. [PMID: 27469501 DOI: 10.1007/s00383-016-3939-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to evaluate the effectiveness of intravenous steroid pulse therapy following balloon dilatation for esophageal stenosis and stricture in children. METHODS The study enrolled six children, including three with congenital esophageal stenosis and three with anastomotic strictures after surgery for esophageal atresia, all of whom were treated by balloon dilatation combined with high-dose intravenous methylprednisolone pulse therapy. Methylprednisolone was injected intravenously at a dose of 20 mg/kg/day for 2 days, starting from the day of dilatation, followed by 10 mg/kg/day for 2 days, for a total of 4 days. RESULTS Esophageal stricture recurred in all three patients with congenital esophageal stenosis despite repeated balloon dilatation without methylprednisolone. However, the symptoms of dysphagia improved and did not recur after systemic steroid pulse therapy following balloon dilatation. Symptoms also resolved in all three patients with anastomotic strictures following balloon dilatation with systemic steroid pulse therapy. All six patients remained asymptomatic after 6-21 months follow-up, with no complications. CONCLUSION Intravenous methylprednisolone pulse therapy following balloon dilatation is safe and effective for the treatment of esophageal stenosis and strictures in children.
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Affiliation(s)
- Kazuki Yokota
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
| | - Akihide Tanano
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Naruhiko Murase
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Kazuo Oshima
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Ryo Shirotsuki
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Kosuke Chiba
- Department of Pediatric Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
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Ahmad A, Wong Kee Song LM, Absah I. Esophageal stent placement as a therapeutic option for iatrogenic esophageal perforation in children. Avicenna J Med 2016; 6:51-3. [PMID: 27144142 PMCID: PMC4849189 DOI: 10.4103/2231-0770.179552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Iatrogenic esophageal perforation (IEP) is a potentially serious adverse event of interventional endoscopy. The approach to IEP varies from surgical repair for large perforations to conservative treatment for small contained perforations. We report a case of an 18-month-old girl with congenital esophageal stenosis suffering a large esophageal perforation after a trial of stricture dilatation, which was successfully managed by the placement of fully covered stent. Hence, in selected cases, esophageal stent placement is a feasible alternative to invasive surgery in managing IEP.
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Affiliation(s)
- Alsafadi Ahmad
- Pediatrics and Adult Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Imad Absah
- Pediatrics and Adult Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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36
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Management of congenital esophageal stenosis associated with esophageal atresia and its impact on postoperative esophageal stricture. ANNALS OF PEDIATRIC SURGERY 2016. [DOI: 10.1097/01.xps.0000482656.06000.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Dall’Oglio L, Caldaro T, Foschia F, Faraci S, Federici di Abriola G, Rea F, Romeo E, Torroni F, Angelino G, De Angelis P. Endoscopic management of esophageal stenosis in children: New and traditional treatments. World J Gastrointest Endosc 2016; 8:212-219. [PMID: 26962403 PMCID: PMC4766254 DOI: 10.4253/wjge.v8.i4.212] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 10/14/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
Post-esophageal atresia anastomotic strictures and post-corrosive esophagitis are the most frequent types of cicatricial esophageal stricture. Congenital esophageal stenosis has been reported to be a rare but typical disease in children; other pediatric conditions are peptic, eosinophilic esophagitis and dystrophic recessive epidermolysis bullosa strictures. The conservative treatment of esophageal stenosis and strictures (ES) rather than surgery is a well-known strategy for children. Before planning esophageal dilation, the esophageal morphology should be assessed in detail for its length, aspect, number and level, and different conservative strategies should be chosen accordingly. Endoscopic dilators and techniques that involve different adjuvant treatment strategies have been reported and depend on the stricture’s etiology, the availability of different tools and the operator’s experience and preferences. Balloon and semirigid dilators are the most frequently used tools. No high-quality studies have reported on the differences in the efficacies and rates of complications associated with these two types of dilators. There is no consensus in the literature regarding the frequency of dilations or the diameter that should be achieved. The use of adjuvant treatments has been reported in cases of recalcitrant stenosis or strictures with evidence of dysphagic symptoms. Corticosteroids (either systemically or locally injected), the local application of mitomycin C, diathermy and laser ES sectioning have been reported. Some authors have suggested that stenting can reduce both the number of dilations and the treatment length. In many cases, this strategy is effective when either metallic or plastic stents are utilized. Treatment complications, such esophageal perforations, can be conservatively managed, considering surgery only in cases with severe pleural cavity involvement. In cases of stricture relapse, even if such relapses occur following the execution of well-conducted conservative strategies, surgical stricture resection and anastomosis or esophageal substitution are the only remaining options.
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Hu HT, Shin JH, Kim JH, Jang JK, Park JH, Kim TH, Nam DH, Song HY. Fluoroscopically guided large balloon dilatation for treating congenital esophageal stenosis in children. Jpn J Radiol 2015; 33:418-423. [PMID: 26032928 DOI: 10.1007/s11604-015-0441-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/18/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to evaluate the safety and clinical effectiveness of fluoroscopically guided large balloon dilatation for treating congenital esophageal stenosis in children. METHODS Our study included seven children (mean age 4.0 years) who underwent a total of ten balloon dilatation sessions. The initial balloon diameters were 10-15 mm. The technical success, clinical success (improved food intake and reduced dysphagia within 1 month following the first balloon dilatation), dysphagia recurrence, and complications were retrospectively evaluated. RESULTS Technical and clinical success rates were 100 %. During the mean 38-month follow-up period after the first balloon dilatation, 3 (43 %) patients underwent only one additional balloon dilatation 4-5 months after the first balloon dilatation for dysphagia recurrence. Two of them showed improvement without further recurrence, while the remaining one underwent partial esophagectomy. Well-contained transmural esophageal rupture (type 2) occurred in two (29 %, 2/7) patients and during two (20 %, 2/10) balloon dilatation sessions. All ruptures were successfully treated conservatively. CONCLUSIONS Our study showed that fluoroscopically guided large balloon dilatation seems to be a simple and effective primary treatment technique for congenital esophageal stenosis in children. Esophageal ruptures were not uncommon although they were not fatal.
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Affiliation(s)
- Hong-Tao Hu
- Department of Radiology, Henan Cancer Hospital/The Affiliated Cancer Hospital of Zhengzhou University, 127 Dongming Road, Zhengzhou, Henan Province, China
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Gastroscopy in pediatric surgery: indications, complications, outcomes, and ethical aspects. Gastroenterol Res Pract 2015; 2015:820340. [PMID: 25883646 PMCID: PMC4389833 DOI: 10.1155/2015/820340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of this study was to map gastroscopies performed at a single tertiary pediatric surgery centre to investigate indications, complications, outcomes, and ethical aspects. Material and Methods. A retrospective study of gastroscopies performed during two time periods (2001-2004 and 2011-2014) was conducted. Data regarding indications, outcomes, and complications of pediatric gastroscopies were analysed from a prospectively collected database. Results. The indications for gastroscopies changed over time. Therefore, 376 gastroscopies performed from 2011 through 2014 were studied separately. The median patient was four years old. The predominant indications were laparoscopic gastrostomy (40%), investigation of gastroenterological conditions (22%), obstruction in the upper gastrointestinal tract (20%), gastroesophageal reflux disease (GERD) (15%), and other indications (3%). Percentages of gastroscopies with no positive findings for each condition were laparoscopic gastrostomy, 100%; gastroenterological conditions, 46%; obstruction in the upper gastrointestinal tract, 36%; GERD, 51%. Furthermore, gastroscopies did not lead to any further action or change in treatment in 45% of gastroenterological conditions and 72% of GERD cases. The overall complication rate was 1%. Conclusion. The results are valuable to educate pediatric surgeons and to inform health care planning when including gastroscopy within clinical practice.
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Terui K, Saito T, Mitsunaga T, Nakata M, Yoshida H. Endoscopic management for congenital esophageal stenosis: A systematic review. World J Gastrointest Endosc 2015; 7:183-191. [PMID: 25789088 PMCID: PMC4360436 DOI: 10.4253/wjge.v7.i3.183] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 12/12/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023] Open
Abstract
Congenital esophageal stenosis (CES) is an extremely rare malformation, and standard treatment have not been completely established. By years of clinical research, evidence has been accumulated. We conducted systematic review to assess outcomes of the treatment for CES, especially the role of endoscopic modalities. A total of 144 literatures were screened and reviewed. CES was categorized in fibromuscular thickening, tracheobronchial remnants (TBR) and membranous web, and the frequency was 54%, 30% and 16%, respectively. Therapeutic option includes surgery and dilatation, and surgery tends to be reserved for ineffective dilatation. An essential point is that dilatation for TBR type of CES has low success rate and high rate of perforation. TBR can be distinguished by using endoscopic ultrasonography (EUS). Overall success rate of dilatation for CES with or without case selection by using EUS was 90% and 29%, respectively. Overall rate of perforation with or without case selection was 7% and 24%, respectively. By case selection using EUS, high success rate with low rate of perforation could be achieved. In conclusion, endoscopic dilatation has been established as a primary therapy for CES except TBR type. Repetitive dilatation with gradual step-up might be one of safe ways to minimize the risk of perforation.
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Zhou YQ, Wang HC, He J, Luo YY. Evidence-based nursing in infants with congenital megacolon. Shijie Huaren Xiaohua Zazhi 2014; 22:5184-5187. [DOI: 10.11569/wcjd.v22.i33.5184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical significance of evidence-based nursing in infantile patients with congenital megacolon.
METHODS: Fifty infantile patients with congenital megacolon hospitalized at our hospital from January 2008 to December 2013 were retrospectively analyzed. According to the measure of nursing intervention after admission, the patients were divided into either a conventional nursing group or an evidence-based nursing group. The nursing effects were compared between the two groups.
RESULTS: Complications occurred only in 3 cases in the evidence-based nursing group, and none of them had multiple simultaneous complications. In contrast, complications occurred in 61 children in the conventional nursing group, of whom 6 developed only one complication, 17 had two concurrent complications, and 7 had three complications (χ2 = 41.667, P = 0.000). The incidences of water and electrolyte imbalance, malnutrition, and hemodynamic instability were significantly lower in the evidence-based nursing group than in the conventional nursing group (P < 0.05). The length of hospital stay and the incidence of anastomotic obstruction were also significantly lower in the evidence-based nursing group than in the conventional nursing group (P < 0.05).
CONCLUSION: Evidence-based nursing may be helpful to reduce the incidence of complications and shorten the length of hospital stays in patients with congenital megacolon.
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