Efficacy and histopathological esophageal wall damage of biodegradable esophageal stents for treatment of severe refractory esophageal anastomotic stricture in a child with long gap esophageal atresia

Abstract

A case in which a self-expandable biodegradable (BD) esophageal stent was used for a refractory esophageal anastomotic stricture (EAS) in a 5-year-old female is presented. The patient underwent closure of a tracheoesophageal fistula and gastrostomy in the neonatal period. Esophagoesophagostomy was performed at 18 months of age after a multistaged extrathoracic esophageal elongation procedure. The patient developed refractory EAS and required repeated esophageal balloon dilation. Four sessions of esophageal BD stenting were performed from the age of 5-8 years. Each BD stenting allowed her to eat chopped food, but the anastomotic stricture recurred 4-7 months after the procedure. No major complications were observed, though transient chest pain and dysphagia were observed after each stenting. Finally, at 8 years of age, EAS resection and esophagoesophageal anastomosis were performed. The resected specimens showed thickened scar formation at the EAS lesion, while the degree of esophageal wall damage, both at the proximal and distal ends of the stricture, was slight. To the best of our knowledge, this is the first case report of this kind of treatment and assessment of damage to the esophageal wall microscopically. The advantages and problems of the use of BD stents in children are discussed.

The timing of oesophageal dilatations in anastomotic stenosis after one-stage anastomosis for congenital oesophageal atresia

“…For infants with unsatisfactory effects of continuous dilatation, other conservative treatment methods have also been reported, including sterol injection, oesophageal stent placement and endoscopic stenosis incision [ 7 , 25 ]. When conservative treatment fails, oesophageal replacement therapy may eventually be required [ 2 ].…”

Individually designed fully covered self-expandable metal stents for pediatric refractory benign esophageal strictures

“…In case 5, the stent was in place for 95 days, causing hyperplasia of inflammatory granulation tissue at the bottom of the stent, while in case 9, stent embedding caused reactive tissue overgrowth after 88 days of stent implantation. It has been reported that children with stent placement are more likely to have inflammatory polyp hyperplasia 26 for the following reasons: first, inflammatory polyps might be caused by the stent as a pro-inflammatory stimulus to the esophageal wall mucosa; second, because of esophageal peristalsis, the stent will repeatedly rub the mucosa of the esophageal wall, and especially the expansion of the bell mouth at both ends could produce a transverse cutting force with the flexible esophagus, resulting in mechanical injury of the esophagus; third, if the stent implantation is too long, gastric acid reflux may corrode the esophageal mucosa, leading to granulation tissue hyperplasia 27 . The enlarged inflammatory polyps usually do not need special treatment and tend to disappear after the pro-inflammatory stimulus is removed.…”

Complete resolution of dysphagia after sequential Polyflex� stenting in a case of recurrent anastomotic stenosis in an adult with congenital esophageal atresia

“…The use of stents in esophageal atresia is not rare in children (8). A lot of devices have been used, from fully-covered self-expandable metallic stent to biodegradable and plastic stents (5,6,9). However, there is no consensus with regard to the most appropriate approach and stent for this indication.…”