Results of a new technique in the treatment of severe esophageal stenosis in children: poliflex stents.

ABSTRACT

OBJECTIVES: The authors present their experience in treating cases of severe esophageal stenosis resistant to conventional dilatation through the placement of silicone stents, describe a precise placement technique, and establish a standard protocol for the use of these devices. METHODS: The authors detail the placement procedure and follow-up in a series of 10 patients (5 male, 5 female) between 1 and 23 years, in whom the technique was used. Nine patients had severe esophageal scarring caused by alkaline agents, and another had severe stenosis resulting from esophageal atresia; all were included in the dilatation program from the age of 6 months to 19 years. The method employs a self-expanding biocompatible stent that is placed using a special applicator over the stenotic area after performing a dilatation. This is maintained long enough to guarantee esophageal scarring without stenosis, permitting oral feeding of the patient. In general, the children experienced nausea and some vomiting during periods lasting from 12 to 48 hours; these episodes were more common when the lesion was higher and longer. Treatment with midazolam and ondansetron relieved the symptoms. All patients received omeprazole while the stent was in place. RESULTS: Five patients received one stent, four others required two, and another needed three because of restenosis. In the five patients who required stent replacement, a low dose of steroids (0.3 mg/kg/24 h) was administered 2 weeks before and also during the placement time. Currently, five patients are completely cured, with follow-up ranging from 4 to 19 months. Three patients now require stent replacement, and two others are under observation after having the stent removed. Long-term tolerance to the stent has been excellent in all cases. The time the stent was in place varied from 20 to 133 days. CONCLUSIONS: The siliconated polypropylene stents (Poliflex/Rüsch) appear to be a promising new tool in the conservative treatment of esophageal stenosis. The stents permit normal feeding during application, substantially reduce treatment time, and avoid repeated anesthesia sessions for dilatations.