Published online Feb 25, 2016. doi: 10.4253/wjge.v8.i4.212
Peer-review started: May 26, 2015
First decision: August 31, 2015
Revised: October 14, 2015
Accepted: December 16, 2015
Article in press: December 18, 2015
Published online: February 25, 2016
Post-esophageal atresia anastomotic strictures and post-corrosive esophagitis are the most frequent types of cicatricial esophageal stricture. Congenital esophageal stenosis has been reported to be a rare but typical disease in children; other pediatric conditions are peptic, eosinophilic esophagitis and dystrophic recessive epidermolysis bullosa strictures. The conservative treatment of esophageal stenosis and strictures (ES) rather than surgery is a well-known strategy for children. Before planning esophageal dilation, the esophageal morphology should be assessed in detail for its length, aspect, number and level, and different conservative strategies should be chosen accordingly. Endoscopic dilators and techniques that involve different adjuvant treatment strategies have been reported and depend on the stricture’s etiology, the availability of different tools and the operator’s experience and preferences. Balloon and semirigid dilators are the most frequently used tools. No high-quality studies have reported on the differences in the efficacies and rates of complications associated with these two types of dilators. There is no consensus in the literature regarding the frequency of dilations or the diameter that should be achieved. The use of adjuvant treatments has been reported in cases of recalcitrant stenosis or strictures with evidence of dysphagic symptoms. Corticosteroids (either systemically or locally injected), the local application of mitomycin C, diathermy and laser ES sectioning have been reported. Some authors have suggested that stenting can reduce both the number of dilations and the treatment length. In many cases, this strategy is effective when either metallic or plastic stents are utilized. Treatment complications, such esophageal perforations, can be conservatively managed, considering surgery only in cases with severe pleural cavity involvement. In cases of stricture relapse, even if such relapses occur following the execution of well-conducted conservative strategies, surgical stricture resection and anastomosis or esophageal substitution are the only remaining options.
Core tip: The paper reviews the conservative treatment of esophageal stenosis and strictures (ES) in children. Different types of ES are discussed, including post-esophageal atresia anastomotic strictures, congenital esophageal stenosis and dystrophic recessive epidermolysis bullosa strictures. Endoscopic techniques are reviewed, including balloon and semirigid dilators, esophageal stents and different adjuvant treatment strategies, like corticosteroids (either systemically or locally injected), the local application of mitomycin C, and ES incision. Conservative management must be considered also for complications, such esophageal perforations, except for patients with severe pleural cavity involvement, who require surgery.