Chantal A Ten Kate1, John Vlot2, Cornelius E J Sloots3, Erica L T van den Akker4, Rene M H Wijnen5. 1. Department of Pediatric Surgery and Intensive Care, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: c.tenkate@erasmusmc.nl. 2. Department of Pediatric Surgery and Intensive Care, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: john.vlot@erasmusmc.nl. 3. Department of Pediatric Surgery and Intensive Care, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: c.sloots@erasmusmc.nl. 4. Department of Pediatric Endocrinology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: e.l.t.vandenakker@erasmusmc.nl. 5. Department of Pediatric Surgery and Intensive Care, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: r.wijnen@erasmusmc.nl.
Abstract
BACKGROUND: The most frequent complication after esophageal atresia repair remains anastomotic stricture formation. The initial treatment is endoscopic dilatation. Intralesional steroid injection (ISI) might be an effective adjuvant treatment in case of recurrent strictures. In this series we present our initial experience with this intervention. METHODS: Data on primary surgery, stricture treatment, postoperative complications, outcome and growth were retrospectively collected from electronic patient records. Findings were analyzed by descriptive statistics and mixed model analysis. RESULTS: Between 2014 and 2017, ISI was performed for severe recurrent anastomotic strictures in six patients (median age at injection 12.4 (2.1-34.7) months) after a median of 6 (2-20) dilatations. In five patients ISI was successful and the stenosis was cleared. No postoperative complications were reported, especially none related to acute adrenal suppression. Comparing the year before with the year after ISI, a significant positive change for weight (r = 0.70, p = 0.003) was calculated versus a negative change for height (r = -0.87, p = 0.003). CONCLUSIONS: We found ISI to be an effective adjuvant treatment to recurrent anastomotic stricture dilatation after esophageal atresia repair, without postoperative complications or symptoms of adrenal suppression. It remains important, however, to monitor growth effects. Further evaluation is required in a large prospective study. TYPE OF STUDY: Treatment study, Level IV (case series).
BACKGROUND: The most frequent complication after esophageal atresia repair remains anastomotic stricture formation. The initial treatment is endoscopic dilatation. Intralesional steroid injection (ISI) might be an effective adjuvant treatment in case of recurrent strictures. In this series we present our initial experience with this intervention. METHODS: Data on primary surgery, stricture treatment, postoperative complications, outcome and growth were retrospectively collected from electronic patient records. Findings were analyzed by descriptive statistics and mixed model analysis. RESULTS: Between 2014 and 2017, ISI was performed for severe recurrent anastomotic strictures in six patients (median age at injection 12.4 (2.1-34.7) months) after a median of 6 (2-20) dilatations. In five patientsISI was successful and the stenosis was cleared. No postoperative complications were reported, especially none related to acute adrenal suppression. Comparing the year before with the year after ISI, a significant positive change for weight (r = 0.70, p = 0.003) was calculated versus a negative change for height (r = -0.87, p = 0.003). CONCLUSIONS: We found ISI to be an effective adjuvant treatment to recurrent anastomotic stricture dilatation after esophageal atresia repair, without postoperative complications or symptoms of adrenal suppression. It remains important, however, to monitor growth effects. Further evaluation is required in a large prospective study. TYPE OF STUDY: Treatment study, Level IV (case series).
Authors: Chantal A Ten Kate; John Vlot; Hanneke IJsselstijn; Karel Allegaert; Manon C W Spaander; Marten J Poley; Joost van Rosmalen; Erica L T van den Akker; Rene M H Wijnen Journal: BMJ Open Date: 2019-12-16 Impact factor: 2.692
Authors: Chantal A Ten Kate; Renato Tambucci; John Vlot; Manon C W Spaander; Frederic Gottrand; Rene M H Wijnen; Luigi Dall'Oglio Journal: Surg Endosc Date: 2020-08-03 Impact factor: 4.584