title: Externally removable stents in the treatment of benign recalcitrant strictures and esophageal perforations in pediatric patients with esophageal atresia.
abstract: BACKGROUND
  We investigated whether removable stents, such as self-expandable plastic stents (SEPSs) and fully covered self-expandable metal stents (FCSEMSs) could provide an alternative treatment for recalcitrant strictures and esophageal perforations after esophageal atresia (EA) repair.
  
  
  OBJECTIVE
  The primary aim of our study was to evaluate technical feasibility. Secondary aims were to evaluate safety and procedural success.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  A total of 24 children with EA.
  
  
  METHODS
  Retrospective review of all children with EA who underwent dilation and esophageal stent placement from January 2010 to February 2013 at our institution.
  
  
  METHODS
  Healing of perforation and stricture resolution at 30 and 90 days.
  
  
  RESULTS
  A total of 41 stents (SEPSs 14, FCSEMSs 27) were placed in 24 patients with EA during the study period, including 14 who had developed esophageal leaks. Procedural success of esophageal stent placement in the treatment of refractory strictures was 39% at 30 days and 26% at 90 days. The success rate was 80% for closure of esophageal perforations with stent therapy after dilation and 25% for perforations associated with surgical repair. Adverse events of stent placement included migration (21% of SEPSs and 7% of FCSEMSs), granulation tissue (37% of FCSEMSs), and deep ulcerations (22% of FCSEMSs).
  
  
  CONCLUSIONS
  Retrospective study with small sample size.
  
  
  CONCLUSIONS
  SEPSs and FCSEMSs can be placed successfully in small infants and children with a history of EA repair. The stents appear to be safe and beneficial in closing esophageal perforations, especially post-dilation. However, a high stricture recurrence rate after stent removal may limit their usefulness in treating recalcitrant esophageal anastomotic strictures.
authors.affiliation: Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts, USA; Esophageal Atresia Treatment Program, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Manfredi
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Esophageal Atresia Treatment Program, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Russell W
authors.initials: RW
authors.lastname: Jennings
authors.affiliation: Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: M Waseem
authors.initials: MW
authors.lastname: Anjum
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Esophageal Atresia Treatment Program, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Hamilton
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Esophageal Atresia Treatment Program, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: C Jason
authors.initials: CJ
authors.lastname: Smithers
authors.affiliation: Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Jenifer R
authors.initials: JR
authors.lastname: Lightdale
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004106:Dilatation / Q000009:adverse effects; D004867:Equipment Design; D004933:Esophageal Atresia / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology / Q000628:therapy*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006097:Granulation Tissue; D006801:Humans; D007223:Infant; D008297:Male; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D014456:Ulcer / Q000209:etiology