Endoscopic methods to reset the esofagian transit in children with esofagian stenosis

Abstract

Introduction. Since the 15th century various methods of treatment of oesophageal stenosis have been proposed. Endoscopic stricturoplasty is one of the current methods of endoluminal expansion. Material and methods. A study was conducted on a group of 30 children aged one month -17 years, hospitalized at the Pediatric Surgery Clinic, diagnosed with esophageal stenosis.The barium transit reveals dilation in the suprastenotic region; Superior digestive endoscopy finds lumen narrowing.Of the total patients undergoing dilation (30 patients), 8 (26.6%) were patients with esophageal atresia subjected to surgical esophagoplasty,two (6.6%) - with ahalasia of the heart,one (3.3%) - with axial transhyathal hernia complicated with esophageal stenosis. 19 (63.3%) patients had strictures developed as a result of ingestion of foreign substances and bodies with different degrees of chemical aggression.Prior to endoscopic treatment of children, anti-inflammatory, spasmolytic, oily preparations were indicated. During the endoluminal treatment, patients received spasmolytic, reparative and anthibiotic indications.Dilatations were performed under general anesthesia combined with spontaneous breathing and full monitoring. Dilation procedures were performed under visual control via the videoendoscope. Two types of dilators were used: balloon dilator and Savory-Gilliard dilator. The endoluminal treatment cure consists of sessions. Interruption between sessions was 1-3 days. Results. A positive result was considered when the strictures were dilated to the size corresponding to the patient’s age, consistent with the published classifications. The total duration of a treatment course was at most one and a half years. The end of the treatment showed that the evolution was favorable at 66.6%.In 20% of cases, patients are still in treatment. At 3 (10%) the dilation procedure was complicated by perforation. Two out of patients with complications over 3 months restored the sessions of dilation. Surgical esophagoplasty was performed in one patient. Conclusion. Endoscopic stricturoplasty has been shown to be effective, less aggressive, is the only method of endoluminal resolution of esophageal stenosis.