Empleo de stents autoexpandibles de nitinol en el manejo pediátrico de la estenosis cáustica esofágica refractaria / Use of self-expanding nitinol stents in the pediatric management of refractory esophageal caustic stenosis

Introducción: el tratamiento de la estenosis esofágica recurrente secundaria a la ingesta de un cáustico supone una ardua tarea. Los stents esofágicos autoexpandibles pueden ser una alternativa a las dilataciones esofágicas endoscópicas repetidas. Caso clínico: presentamos el caso de un varón de dos años de edad que presenta una estenosis esofágica severa de gran extensión tratada con éxito mediante la combinación de dilataciones y colocación de stents. Después de cinco meses de dilataciones neumáticas seriadas, se introdujeron a través de una gastrostomía tres stents autoexpandibles de nitinol recubiertos internamente de silicona, cubriendo todo el esófago. El procedimiento se realizó bajo control endoscópico y radiológico. Tres meses después fue necesario repetir el tratamiento con un único stent. Una nueva estenosis en esófago proximal necesitó resección quirúrgica y anastomosis seguida de dos dilataciones neumáticas con intervalos asintomáticos progresivamente más largos durante cinco meses. Discusión: los resultados obtenidos son satisfactorios, ya que permiten al paciente conservar y utilizar su propio esófago. Sin embargo, este es un caso único y debe determinarse el tiempo óptimo de mantenimiento y el momento retirada del stent (AU)

Background: The treatment of recurrent esophageal stricture secondary to the ingestion of a caustic agent is an arduous task. Self-expanding esophageal stents may be an alternative to repeated endoscopic esophageal dilations. Case report: We present the case of a two-year-old male with a severe and long esophageal stricture successfully treated by the combination of dilations and stent placement. After five months of serial pneumatic dilations, three self-expanding nitinol stents internally coated with silicone were introduced through a gastrostomy, covering the entire esophagus. The procedure was performed under endoscopic and radiological guidance. Three months later, the treatment was repeated with a single stent. A new stenosis in the proximal esophagus required surgical resection, and anastomosis followed by two pneumatic dilations for five months resulted in longer intervals where the patient was asymptomatic. Discussion: The results obtained were satisfactory, allowing the patient to conserve and use his own esophagus. However, this is a unique case and the optimal maintenance time and withdrawal time of the stent must be determined (AU)

Use of self-expanding nitinol stents in the pediatric management of refractory esophageal caustic stenosis.

BACKGROUND: The treatment of recurrent esophageal stricture secondary to the ingestion of a caustic agent is an arduous task. Self-expanding esophageal stents may be an alternative to repeated endoscopic esophageal dilations. CASE REPORT: We present the case of a two-year-old male with a severe and long esophageal stricture successfully treated by the combination of dilations and stent placement. After five months of serial pneumatic dilations, three self-expanding nitinol stents internally coated with silicone were introduced through a gastrostomy, covering the entire esophagus. The procedure was performed under endoscopic and radiological guidance. Three months later, the treatment was repeated with a single stent. A new stenosis in the proximal esophagus required surgical resection, and anastomosis followed by two pneumatic dilations for five months resulted in longer intervals where the patient was asymptomatic. DISCUSSION: The results obtained were satisfactory, allowing the patient to conserve and use his own esophagus. However, this is a unique case and the optimal maintenance time and withdrawal time of the stent must be determined.

Outcomes of pediatric living donor kidney transplantation: A single-center experience.

Renal transplantation is the treatment of choice for children with ESRD offering advantages of improved survival, growth potential, cognitive development, and quality of life. The aim of our study was to compare the outcomes of LDKT vs DDKT performed in children at a single center. Retrospective chart review of pediatric patients who underwent kidney transplantation from 2005 to 2014 was performed. Ninety-one renal transplants were accomplished, and 31 cases (38.27%) were LDKT, and in 96.7% of the cases, the graft was obtained through laparoscopy. Thirty-four receptors weighted <25 kg. LDKT group had statistically significant lower cold ischemia times than DDKT one. Complication rate was 9.67% for LDKT and 18.33% for DDKT. eGFR was better in LDKT. Patient survival rate was 100% for LDKT and 98.3% for DDKT, and graft survival rate was 96.7% for LDKT and 88.33%-80% for DDKT at a year and 5 years. Our program of pediatric kidney transplantation has achieved optimal patient and graft survival rates with low rate of complications. Living donor pediatric kidney transplants have higher patient and better graft survival rates than deceased donor kidney transplants.