Esophageal stenting may serve as a bridge to definitive surgery in refractory esophageal strictures in children, though this intervention may not lead to complete stricture resolution, according to study results published in the Journal of Pediatric Surgery.
Esophageal stenting is used to treat benign esophageal strictures in adults and children; however, according to investigators, the efficacy of stenting in children and associated complications remain unclear. Researchers in this study aimed to evaluate the outcomes and complication rates associated with self-expanding esophageal stents in children and compare them with existing literature.
In this study, researchers performed a retrospective review of outcomes on children under the age of 18 who underwent stenting for esophageal strictures at a single quaternary pediatric center between January 2003 and August 2018. A systematic review was also conducted in accordance with PRISMA guidelines to identify randomized controlled trials and case series published between 1975 and 2018, in which self-expanding stents were evaluated in 5 or more children. Outcomes following stenting were stratified into the following 4 groups: no further intervention, further intervention, no improvement or further intervention, and unknown long-term outcome.
Through the retrospective review, researchers revealed that 25 patients received 65 esophageal stents that were inserted for the management of esophageal strictures. Overall, 2 patients (8%) required no further treatment, 11 patients (44%) required further dilations, and 8 patients (32%) required esophageal replacement. Stent migration was the most frequently observed complication, occurring in 31 out of 65 cases (48%).
Researchers also revealed that 97 patients received 160 esophageal stents. Overall, 45 patients (46%) required no further treatment, 47 patients (48%) required further treatment, and 2 patients (2%) had no improvement nor further treatment. Stent migration occurred in 23 out of 160 cases (14%) and was the most frequently reported complication.
The main limitations of this study were its small sample size and lack of control group. Investigators did not compare esophageal stenting to other therapeutic options and did not evaluate the use of self-expanding stents for the management of isolated esophageal leaks.
The study researchers concluded that, “Esophageal stents may have a role as a bridge to definitive surgery but complete stricture resolution poststenting is extremely unlikely with a high re-intervention rate.”
Tandon S, Burnand KM, De Coppi P, McLaren CA, Roebuck DJ, Curry JI. Self-expanding esophageal stents for the management of benign refractory esophageal strictures in children: a systematic review and review of outcomes at a single center [published online August 30, 2019]. J Pediatr Surg. doi: 10.1016/j.jpedsurg.2019.08.041