68 Biodegradable stent in the management of oesophageal strictures in children: a case series
Olugbenga Awolaran, Simon McGuirk, Suren Arul
Birmingham Children's Hospital, Birmingham, United Kingdom

Abstract

Aim

Experience with biodegradable stents (BDS) in the management of oesophageal strictures (OS) in children is limited. We report our experience with BDS in 3 children with severe, intractable OS.

Methods

We retrospectively reviewed clinical outcomes of 3 cases of severe OS requiring dilatations under GA every 1-2 months. Following MDT discussion, BDS were inserted to provide longer-term treatment. Custom-made uncovered BDS (ELLA-CS,Hradec Kralove,Czech Republic) was inserted under GA with fluoroscopic guidance.

Results

Stent insertion was initially uncomplicated. There was early migration of stent in one case requiring a second stent. Stent insertion led to significant improvement in swallowing. This was temporary, lasting 1-2months in each case. Recurrent symptoms were as severe as pre-stent insertion. Need for dilatations remained unchanged after BDS. None had complete resolution of stricture/symptoms(Table1). In addition, all cases developed mucosal hyperplasia around BDS that appeared to contribute to recurrent symptoms

Conclusions

  • Stent insertion provided short term relief but did not provide lasting resolution of the stricture. 
  • We would not recommend its routine use in children with long term strictures.

Table 1: Patient characteristics and outcomes.

Case (Age)

Cause of stricture/

Timing of stent

Number of dilatations/year before stent (total dilatations)

Number of BDS stent insertion sessions

Stent related problems

Outcome/ongoing management

Case 1 (13yrs)

 

Caustic ingestion at 16months

 

Stent after 11yrs

5(>30)

2

Haematemesis chest pain

Stent migration

Persistent stricture at proximal & distal ends of stent

 

2-monthly dilatations+/-steroid injection

Case 2

(9yrs)

Caustic ingestion at 18months

 

Stent after 7yrs

10(>30)

1

None

Persistent stricture at proximal & distal ends of stent+within

 

Monthly dilatations+/-steroid injection

Case 3

(2yrs)

Long gap OA (Foker’s technique + delayed anastomosis)

 

Stent 17months post-anastomosis

5(16)

2

none

Persistent severe stricture

 

Indwelling balloon+home dilatation

 


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