STENTING FOR CAUSTIC STRICTURES - ESOPHAGEAL REPLACEMENT REPLACED

Methods: From 1983 to 1996, 31 children with caustic esophageal strict ures were seen at Bambino Gesu Children's Hospital; they were all trea ted conservatively except for two cases complicated by tracheoesophage al fistula. The remaining 29 patients were divided into three groups d epending on the treatment, which was modified over the years. Group A (1983 to 1987) consisted of seven patients treated by periodic dilatat ions; group B (1988 to 1992) consisted of 10 children treated by 40 da ys of esophageal stenting plus dexamethasone, 0.5 mg/kg/d plus ranitid ine plus no oral feeding for 7 to 10 days; group C (1993 to 1996) cons isted of 12 cases treated by 40 days of esophageal stenting plus dexam ethasone, 1 mg/kg/d plus omeprazole plus early oral feeding resumption . Results: No differences were observed between the three groups of pa tients with regard to the mean age and to the ingested substance, wher eas a significant difference (P =.007) was observed in the mean length of the stricture between group A and C (3.4 +/- 1.3 and 5.6 +/- 1.6 c m, respectively). In all but one of the patients (96.5%) complete heal ing of the stenosis was achieved by conservative treatment, with defin itive relief of dysphagia. One patient in group C did not improve afte r a repeated stenting procedure and was surgically treated. However, i n group A, resolution of the stricture was obtained after an average o f 19.9 +/- 14.8 dilatations in a mean period of 25.3 +/- 17.2 months. In group B, a mean of 12 +/- 11.3 dilatations were required in a mean period of treatment of 14.1 +/- 10.6 months. In patients in group C, a mean of 3.5 +/- 3.2 dilatations were necessary in a mean of 5.8 +/- 4 .8 months. A statistically significant difference was observed both wi th regard to the number of dilatations and to the duration of treatmen t, between group A and group C (P =.002) and group B and C (P =.03). C onclusion: Esophageal replacement should be considered only in cases c omplicated by tracheoesophageal fistula or in the rare patients who do not respond to repeated esophageal stenting. Copyright (C) 1998 by W. B. Saunders Company.