Successful treatment of severe refractory anastomotic stricture in an infant after esophageal atresia repair by endoscopic balloon dilation combined with systemic administration of dexamethasone.
A boy with a history of esophageal atresia repair received an esophagoesophagostomy at 14 months for a severe refractory anastomotic stricture, which had already required repeated balloon dilation with intralesional dexamethasone injection. Anastomotic leakage and stricture was again evident after the second surgery, and the patient underwent five procedures of balloon dilations with intralesional dexamethasone injection. Dysphagia was persistent and the patient required dilation every 2-3 weeks. After the sixth dilation, the patient was given 1 mg/kg per day of dexamethasone i.v. for 3 days. Dexamethasone i.v. was tapered during the following 3 days and finished at day 6. A week later, endoscopic findings showed an apparent improvement in the stricture. Another dilation was followed by 1 mg/kg per day dexamethasone i.v. for 7 days, and 0.75 kg/mg per day oral dexamethasone for another 7 days. The stricture improved completely and the anastomosis was patent after the second dilation. The patient is doing well without dysphagia and has not required additional dilation for over 18 months after the last dilation. Balloon dilation in combination with systemic dexamethasone administration may be an effective treatment that could substitute invasive techniques including surgical manipulation for severe refractory strictures.
Department of Pediatric Surgery, Chiba University Hospital, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. hishiki@faculty.chiba-u.jp
Tomoro
T
Hishiki
Katsunori
K
Kouchi
Takeshi
T
Saito
Keita
K
Terui
Yoshiharu
Y
Sato
Tetsuya
T
Mitsunaga
Mitsuyuki
M
Nakata
Hideo
H
Yoshida
D000714:Anastomosis, Surgical / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002404:Catheterization; D003907:Dexamethasone / Q000627:therapeutic use*; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012086:Reoperation
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone