Surgical management of severe peptic esophageal stricture in children

Abstract

Background/aims: In spite of the well-established treatment of gastroesophageal reflux in children, the surgical management of peptic esophageal stricture remains controversial. Previous studies adopted various treatment protocols and included strictures with various degrees of severity. In this study, we selectively reviewed children with severe peptic strictures with various degrees of severity. In this study, we selectively reviewed children with severe peptic strictures treated with a specific treatment protocol of preoperative esophageal dilatation, Nissen's fundoplication and postoperative dilatation.

Methodology: We reviewed medical records of all patients with severe peptic esophageal stricture treated by the above-mentioned protocol at King Khalid University Hospital, Riyadh between 1995 and 2000. Data collected included the following: presenting symptoms, methods of diagnosis and the outcome of therapy.

Results: Ten consecutive patients who were treated for severe reflux esophageal strictures were included. Their age at surgery ranged between 2 to 12 years (mean, 5.6 years). All patients had a trial of medical treatment which failed to give any improvement of symptoms. Subsequently, all patients underwent a protocol of preoperative esophageal dilatation, Nissen's fundoplication and finally postoperative dilatation. Two patients had esophageal perforations: one by the flexible endoscope during the preoperative assessment and the other during preoperative dilatation. There were no mortalities. Eight patients showed marked improvement in their clinical symptoms and complete resolution of strictures radiologically and the remaining two showed significant improvement clinically and radiologically. The average follow-up period was 3 years (range, 1-5 years).

Conclusions: We conclude that preoperative dilatation, Nissen's fundoplication, and postoperative dilatation is an effective approach to treat severe pediatric peptic esophageal strictures. Other aggressive approaches described in the literature such as resection and/or replacement of the stricture are rarely indicated even for the most severe strictures.