The effect of intralesional steroid injections on esophageal strictures and the child as whole: A case series.
Child, Preschool
Dilatation
Esophageal Atresia
/ surgery
Esophageal Stenosis
/ etiology
Esophagoplasty
Female
Glucocorticoids
/ therapeutic use
Humans
Infant
Injections, Intralesional
/ methods
Male
Postoperative Complications
/ therapy
Retrospective Studies
Treatment Outcome
Triamcinolone Acetonide
/ therapeutic use
Anastomotic stricture
Esophageal atresia
Intralesional steroid injection
Triamcinolone acetide
Journal
Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
13
02
2019
revised:
12
04
2019
accepted:
15
05
2019
pubmed:
15
6
2019
medline:
2
10
2020
entrez:
15
6
2019
Statut:
ppublish
Résumé
The most frequent complication after esophageal atresia repair remains anastomotic stricture formation. The initial treatment is endoscopic dilatation. Intralesional steroid injection (ISI) might be an effective adjuvant treatment in case of recurrent strictures. In this series we present our initial experience with this intervention. Data on primary surgery, stricture treatment, postoperative complications, outcome and growth were retrospectively collected from electronic patient records. Findings were analyzed by descriptive statistics and mixed model analysis. Between 2014 and 2017, ISI was performed for severe recurrent anastomotic strictures in six patients (median age at injection 12.4 (2.1-34.7) months) after a median of 6 (2-20) dilatations. In five patients ISI was successful and the stenosis was cleared. No postoperative complications were reported, especially none related to acute adrenal suppression. Comparing the year before with the year after ISI, a significant positive change for weight (r = 0.70, p = 0.003) was calculated versus a negative change for height (r = -0.87, p = 0.003). We found ISI to be an effective adjuvant treatment to recurrent anastomotic stricture dilatation after esophageal atresia repair, without postoperative complications or symptoms of adrenal suppression. It remains important, however, to monitor growth effects. Further evaluation is required in a large prospective study. Treatment study, Level IV (case series).
Sections du résumé
BACKGROUND
BACKGROUND
The most frequent complication after esophageal atresia repair remains anastomotic stricture formation. The initial treatment is endoscopic dilatation. Intralesional steroid injection (ISI) might be an effective adjuvant treatment in case of recurrent strictures. In this series we present our initial experience with this intervention.
METHODS
METHODS
Data on primary surgery, stricture treatment, postoperative complications, outcome and growth were retrospectively collected from electronic patient records. Findings were analyzed by descriptive statistics and mixed model analysis.
RESULTS
RESULTS
Between 2014 and 2017, ISI was performed for severe recurrent anastomotic strictures in six patients (median age at injection 12.4 (2.1-34.7) months) after a median of 6 (2-20) dilatations. In five patients ISI was successful and the stenosis was cleared. No postoperative complications were reported, especially none related to acute adrenal suppression. Comparing the year before with the year after ISI, a significant positive change for weight (r = 0.70, p = 0.003) was calculated versus a negative change for height (r = -0.87, p = 0.003).
CONCLUSIONS
CONCLUSIONS
We found ISI to be an effective adjuvant treatment to recurrent anastomotic stricture dilatation after esophageal atresia repair, without postoperative complications or symptoms of adrenal suppression. It remains important, however, to monitor growth effects. Further evaluation is required in a large prospective study.
TYPE OF STUDY
METHODS
Treatment study, Level IV (case series).
Identifiants
pubmed: 31196669
pii: S0022-3468(19)30361-6
doi: 10.1016/j.jpedsurg.2019.05.013
pii:
doi:
Substances chimiques
Glucocorticoids
0
Triamcinolone Acetonide
F446C597KA
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
646-650Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.