Michael A Manfredi1, Russell W Jennings2, M Waseem Anjum3, Thomas E Hamilton2, C Jason Smithers2, Jenifer R Lightdale3. 1. Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts, USA; Esophageal Atresia Treatment Program, Boston Children's Hospital, Boston, Massachusetts, USA. 2. Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Esophageal Atresia Treatment Program, Boston Children's Hospital, Boston, Massachusetts, USA. 3. Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts, USA.
Abstract
BACKGROUND: We investigated whether removable stents, such as self-expandable plastic stents (SEPSs) and fully covered self-expandable metal stents (FCSEMSs) could provide an alternative treatment for recalcitrant strictures and esophageal perforations after esophageal atresia (EA) repair. OBJECTIVE: The primary aim of our study was to evaluate technical feasibility. Secondary aims were to evaluate safety and procedural success. DESIGN: Retrospective study. SETTING: Tertiary-care referral center. PATIENTS: A total of 24 children with EA. INTERVENTIONS: Retrospective review of all children with EA who underwent dilation and esophageal stent placement from January 2010 to February 2013 at our institution. MAIN OUTCOME MEASUREMENTS: Healing of perforation and stricture resolution at 30 and 90 days. RESULTS: A total of 41 stents (SEPSs 14, FCSEMSs 27) were placed in 24 patients with EA during the study period, including 14 who had developed esophageal leaks. Procedural success of esophageal stent placement in the treatment of refractory strictures was 39% at 30 days and 26% at 90 days. The success rate was 80% for closure of esophageal perforations with stent therapy after dilation and 25% for perforations associated with surgical repair. Adverse events of stent placement included migration (21% of SEPSs and 7% of FCSEMSs), granulation tissue (37% of FCSEMSs), and deep ulcerations (22% of FCSEMSs). LIMITATIONS: Retrospective study with small sample size. CONCLUSION: SEPSs and FCSEMSs can be placed successfully in small infants and children with a history of EA repair. The stents appear to be safe and beneficial in closing esophageal perforations, especially post-dilation. However, a high stricture recurrence rate after stent removal may limit their usefulness in treating recalcitrant esophageal anastomotic strictures.
BACKGROUND: We investigated whether removable stents, such as self-expandable plastic stents (SEPSs) and fully covered self-expandable metal stents (FCSEMSs) could provide an alternative treatment for recalcitrant strictures and esophageal perforations after esophageal atresia (EA) repair. OBJECTIVE: The primary aim of our study was to evaluate technical feasibility. Secondary aims were to evaluate safety and procedural success. DESIGN: Retrospective study. SETTING: Tertiary-care referral center. PATIENTS: A total of 24 children with EA. INTERVENTIONS: Retrospective review of all children with EA who underwent dilation and esophageal stent placement from January 2010 to February 2013 at our institution. MAIN OUTCOME MEASUREMENTS: Healing of perforation and stricture resolution at 30 and 90 days. RESULTS: A total of 41 stents (SEPSs 14, FCSEMSs 27) were placed in 24 patients with EA during the study period, including 14 who had developed esophageal leaks. Procedural success of esophageal stent placement in the treatment of refractory strictures was 39% at 30 days and 26% at 90 days. The success rate was 80% for closure of esophageal perforations with stent therapy after dilation and 25% for perforations associated with surgical repair. Adverse events of stent placement included migration (21% of SEPSs and 7% of FCSEMSs), granulation tissue (37% of FCSEMSs), and deep ulcerations (22% of FCSEMSs). LIMITATIONS: Retrospective study with small sample size. CONCLUSION: SEPSs and FCSEMSs can be placed successfully in small infants and children with a history of EA repair. The stents appear to be safe and beneficial in closing esophageal perforations, especially post-dilation. However, a high stricture recurrence rate after stent removal may limit their usefulness in treating recalcitrant esophageal anastomotic strictures.