alexa Refractory strictures post-esophageal atresia repair: what are the alternatives?


Journal of Gastrointestinal & Digestive System

Author(s): Lvesque D, Baird R, Laberge JM

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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. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus. This article was published in Dis Esophagus and referenced in Journal of Gastrointestinal & Digestive System

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