STRICTUROTOMY AS A THERAPEUTIC ALTERNATIVE IN CHILDREN WITH REFRACTORY ESOPHAGEAL STRICTURE

Abstract

Introduction: Refractory esophageal stenosis is one in which, after a maximum of 5 dilation sessions and a 4-week interval between them, optimal intake and nutritional status cannot be guaranteed according to the child's age. Conservative management is preferred before surgery, and there are therapeutic endoscopic options such as conventional dilation, mitomycin C, intralesional triamcinolone, platelet-rich plasma, among others; whose success rate is variable. Stricturotomy consists of making radial incisions around the edges of the stricture, in order to break the fibrotic tissue, enlarge the esophageal lumen and reduce dysphagia. It has been described as an alternative treatment for refractory esophageal stenosis, with little information in pediatrics. Objective: To evaluate stricturotomy as a therapeutic alternative in children with refractory esophageal stricture. Methods: Quasi-experimental, prospective, longitudinal study, whose sample was represented by 13 patients. Results: Preschool age was the most affected 61.5%, predominantly male. The degree of dysphagia according to the Knyrim scale was greater than 3 in 84.6%. In 92.3% of cases, the clinical response was favorable, improving tolerance of oral food and nutritional status; while endoscopically the diameter of the esophageal lumen increased. Conclusions: Stricturotomy was found to be an effective endoscopic technique for the treatment of refractory esophageal stricture.