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Esophageal Stricture
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Esophageal Dilation for children with Esophageal Atresia
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Animation video [in English]. Target audience: Parents and families. The video could also be used as an explanatory tool by healthcare professionals.
This is an ERNICA animation. Please consult your own care provider for local protocols.
video3:34 · Nov 2023
If performing endoscopy and capable of removing a battery from the stomach endoscopically, removal is advocated because you are already there. — Dan, Button Battery Ingestion · 12:27
Button Battery Ingestion
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At the 7th Annual Pediatric Surgery Update Course, Dr. Daniel von Allmen discusses management after button battery ingestion.
video14:28 · Mar 2020
Stricture formation remains the most frequent post-operative complication in more than half of the cases of esophageal atresia. — Anfleur von Hall, STEPS-EA trial: Esophageal Atresia · 1:15
STEPS-EA trial: Esophageal Atresia
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video3:19 · Nov 2023
Expert statements from the recordings in this collection.
STEPS-EA trial: Esophageal Atresia
The standard treatment for esophageal atresia is surgery with an end to end anastomosis to restore continuity.
Anfleur von Hall1:00
Stricture formation remains the most frequent post-operative complication in more than half of the cases of esophageal atresia.
Anfleur von Hall1:15
The standard treatment for esophageal stricture is endoscopic dilatation either by bouginage or by balloon dilatation.
Anfleur von Hall1:25
Worldwide, the balloon is most frequently used for esophageal stricture dilatation.
Anfleur von Hall1:35
Intralesional steroid injections use triamcinolone (Kenalog) as the most common agent.
Anfleur von Hall1:50
Steroids inhibit the formation of collagen, enhance its breakdown, and decrease fibrotic healing in esophageal strictures.
Anfleur von Hall1:55
Each of the four quadrants of the esophageal stricture is injected with steroid in the STEPS-EA protocol.
Anfleur von Hall2:05
110 children born with esophageal atresia are needed to prove the effectiveness of the steroid injection.
Anfleur von Hall2:25
Study Group A will be injected with triamcinolone and then undergo balloon dilatation, while Study Group B will only undergo balloon dilatation.
Anfleur von Hall2:32
A second esophagram will be performed to objectify the effectiveness of the intervention on the length and diameter of the stricture.
Anfleur von Hall2:50
Physical length and weight will be measured at 4 time points throughout the 6 month study period to investigate possible systemic side effects of steroid injection.
Anfleur von Hall3:00
A hair sample will be collected at the end of the follow-up period to measure cortisol levels to investigate possible systemic effects of intralesional steroid injection.
Anfleur von Hall3:10
Esophageal Dilation for children with Esophageal Atresia
Children with esophageal atresia usually have their esophagus surgically repaired shortly after birth.
After surgical repair of esophageal atresia, it is common for children to develop an abnormal narrowing (stricture or stenosis) at the anastomosis site where the two halves were joined.
Esophageal strictures prevent normal passage of food to the stomach.
Children with esophageal strictures may take longer to eat than usual and may show breathing difficulties whilst drinking.
Signs of stricture may only become apparent when children start eating solid foods at a later age, with solid foods becoming stuck and causing discomfort and dysphagia.
All patients born with esophageal atresia should be treated at a specialist center with a multidisciplinary team.
Contrast esophagography for stricture evaluation involves passing a small tube through the nose into the esophagus above the narrowed part, injecting special fluid, and observing on X-ray to assess stricture tightness and fluid passage.
Esophageal dilation is always done under general anesthesia.
In most cases of esophageal dilation, an endoscope is used to insert a small balloon inside the stricture, which inflates to stretch open the stricture before being removed.
An alternative dilation technique uses the endoscope to pass a tapered elastic tube called a bougie into the esophagus to the stricture, with serial tubes of increasing diameter used to gradually stretch the stricture.
After esophageal dilation, oral feeding can restart under clinical observation, which might require a few hours or sometimes overnight hospital stay.
Strictures can recur after dilation and often the same procedure is needed multiple times before the esophagus is wide enough to pass food sufficiently.
Most cases of esophageal stricture can be managed with 1, 2, or 3 dilation procedures.
In rare cases, additional treatments beyond dilation may be needed for esophageal strictures.
Follow-up support for esophageal atresia should be both lifelong and structured.
Button Battery Ingestion
Button battery ingestions are becoming more frequent, with national data suggesting increasing numbers of emergency department visits.
Dan0:01
A radiographic ring around the edge of a circular object on X-ray indicates a button battery rather than a quarter.
Dan1:30
The Foley catheter technique may work for button battery removal in limited situations when the operating room cannot be accessed quickly and there is short duration of symptoms without likely perforation.
Dan2:10