title: Refractory strictures post-esophageal atresia repair: what are the alternatives?
abstract: Esophageal strictures remain the most frequent complication after esophageal atresia (EA) repair despite refinements in operative techniques. With an incidence of anastomotic stricture between 8% and 49%, EA is the most frequent cause of benign esophageal stricture in children. The mainstay of treatment for esophageal stricture is dilatation with a 58-96% success rate. In order to relieve dysphagia, between 1 and 15 dilatations will be required in each EA patient with an esophageal stricture. However dilatations may lead to complications including perforation (0.1-0.4% of all esophageal benign strictures) and sociopsychological morbidity. Fifty percent of EA strictures will improve in 6 months. However, 30% will persist and require repeat dilatations. The present article explores the variety of non-surgical alternative treatments for anastomotic strictures after EA repair, focusing on triamcinolone acetonide, mitomycin C and esophageal stents. We propose an algorithm for a more standardized therapeutic approach, with the hope that an international panel of experts could meet and establish a consensus.
authors.affiliation: Gastroenterology and Pediatric General Surgery Divisions, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada H3H1P3. dominique.levesque@muhc.mcgill.ca
authors.forename: D
authors.initials: D
authors.lastname: Lévesque
authors.forename: R
authors.initials: R
authors.lastname: Baird
authors.forename: J-M
authors.initials: JM
authors.lastname: Laberge
mesh_terms: D000465:Algorithms; D000714:Anastomosis, Surgical; D003131:Combined Modality Therapy; D003661:Decision Support Techniques; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004944:Esophagoplasty; D004947:Esophagus / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D015552:Injections, Intralesional; D016685:Mitomycin / Q000627:therapeutic use; D019384:Nucleic Acid Synthesis Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin; D014222:Triamcinolone Acetonide