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2018, Number 5

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Rev Mex Pediatr 2018; 85 (5)

Effectiveness of intralesional triamcinolone for recurrent/refractory esophageal stricture in children

Blanco-Rodríguez G, Sánchez-Hernández F, Teyssier-Morales G, Penchyna-Grub J, Zurita-Cruz JN

Language: Spanish
References: 24
Page: 168-173
PDF size: 287.82 Kb.


ABSTRACT

Introduction: Knowledge about triamcinolone utility for esophagitis in children is limited. Objective: To compare the therapeutic treatment of the intralesional use of triamcinolone in pediatric patients with recurrent or refractory esophageal stenosis. Patients, materials and methods: Analysis of nine pediatric cases. Patients under 18 years of age with a diagnosis of recurrent or refractory esophageal stricture were included. Triamcinolone was applied through endoscopy in the four quadrants of the lesion every two to four weeks, in three sessions, and with six months of follow-up. Frequency of dilations was assessed before and after the administration of the drug. Statistical analysis: the Wilcoxon test was applied to compare the periodic rate of dilations. Results: Median age of four years were included. There was a statistical difference between the RPD before and after the triamcinolone (0.81 vs. zero, p ‹ 0.05). Conclusions: Periodic dilation, along with the application of intralesional triamcinolone, was effective in pediatric patients with refractory/recurrent and complex esophageal strictures, with a maximum follow-up of six months.


REFERENCES

  1. Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013; 19(25): 3918-3930.

  2. Chirica M, Bonavina L, Kelly MD, Sarfati E, Cattan P. Caustic ingestion. Lancet. 2017; 389(10083): 2041-2052.

  3. Van Boeckel PG, Siersema PD. Refractory esophageal strictures: what to do when dilation fails. Curr Treat Options Gastroenterol. 2015; 13(1): 47-58.

  4. Dall’Oglio L, Caldaro T, Foschia F, Faraci S, Federici di Abriola G, Rea F et al. Endoscopic management of esophageal stenosis in children: new and traditional treatments. World J Gastrointest Endosc. 2016; 8(4): 212-219.

  5. Siersema PD. Treatment options for esophageal strictures. Nat Clin Pract Gastroenterol Hepatol. 2008; 5(3): 142-152.

  6. Manfredi MA. Endoscopic management of anastomotic esophageal strictures secondary to esophageal atresia. Gastrointest Endosc Clin N Am. 2016; 26(1): 201-219.

  7. Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005; 62(3): 474-475.

  8. Lévesque D, Baird R, Laberge JM. Refractory strictures post-esophageal atresia repair: what are the alternatives? Dis Esophagus. 2013; 26(4): 382-387.

  9. Kochhar R, Poornachandra KS. Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures. World J Gastrointest Endosc. 2010; 2(2): 61-68.

  10. De Lusong MAA, Timbol ABG, Tuazon DJS. Management of esophageal caustic injury. World J Gastrointest Pharmacol Ther. 2017; 8(2): 90-98.

  11. Castaño LR, Sanín FE, Ruiz VMH, Juliao BF, Erebrie F. Dilatación endoscópica y aplicación de esteroides intralesionales en las estenosis esofágicas por cáusticos y posquirúrgicas. Rev Col Gastroenterol. 2005; 20(2): 06-11.

  12. Holder TM, Ashcraft KW, Leape L. The treatment of patients with esophageal strictures by local steroid injections. J Pediatr Surg. 1969; 4(6): 646-653.

  13. Kochhar R, Ray JD, Sriram PV, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointest Endosc. 1999; 49(4 Pt 1): 509-513.

  14. Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointest Endosc. 2002; 56(6): 829-834.

  15. Bicakci U, Tander B, Deveci G, Rizalar R, Ariturk E, Bernay F. Minimally invasive management of children with caustic ingestion: less pain for patients. Pediatr Surg Int. 2010; 26(3): 251-255.

  16. Berenson GA, Wyllie R, Caulfield M, Steffen R. Intralesional steroids in the treatment of refractory esophageal strictures. J Pediatr Gastroenterol Nutr. 1994; 18(2): 250-252.

  17. Altintas E, Kacar S, Tunc B, Sezgin O, Parlak E, Altiparmak E et al. Intralesional steroid injection in benign esophageal strictures resistant to bougie dilation. J Gastroenterol Hepatol. 2004; 19(12): 1388-1391.

  18. Spechler SJ. American Gastroenterological Association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. 1999; 117(1): 229-233.

  19. Radecke K, Gerken G, Treichel U. Impact of a self-expanding, plastic esophageal stent on various esophageal stenoses, fistulas, and leakages: a single-center experience in 39 patients. Gastrointest Endosc. 2005; 61(7): 812-818.

  20. Zhang C, Zhou X, Yu L, Ding J, Shi R. Endoscopic therapy in the treatment of caustic esophageal stricture: a retrospective case series study. Dig Endosc. 2013; 25(5): 490-495.

  21. Sabanathan S, Salama FD, Morgan WE. Oesophageal intramural pseudodiverticulosis. Thorax. 1985; 40(11): 849-857.

  22. Gandhi RP, Cooper A, Barlow BA. Successful management of esophageal strictures without resection or replacement. J Pediatr Surg. 1989; 24(8): 745-749; discussion 749-750.

  23. Zein NN, Greseth JM, Perrault J. Endoscopic intralesional steroid injections in the management of refractory esophageal strictures. Gastrointest Endosc. 1995; 41(6): 596-598.

  24. Pelclová D, Navrátil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev. 2005; 24(2): 125-129.




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