About this Research Topic
Stenosis at the site of anastomoses in esophageal atresia and after an esophageal corrosive burn are well-known problems that pediatricians and pediatric surgeons confront frequently. Unfortunately, there is considerable variability throughout the world concerning the indications for stricture therapy and the way they are treated. When we discuss a refractory stricture, it is often questioned which treatment modalities have proven to be worthwhile. Better information is needed in regards to treatment modalities such as the execution of dilatations, stent-implantations, administration of cortisone or mitomycin and indications for stenosis resection.
The overall goal of this collection is to highlight aspects of the management of esophageal stenosis in children with particular focus upon diagnostic tests and the various treatments available. In this Research Topic, we aim to address the following questions concerning diagnostic investigations, indication and treatment of esophageal stenosis and refractory strictures.
An important basic question is which stenosis needs to be treated: Those which are symptomatic or those visible during upper gastrointestinal studies or endoscopy? Should the child be checked for stenosis in a regular scheduled manner or on demand only? If routine examinations – until what age? What are advantages and disadvantages of either procedure?
Concerning balloon-dilatation - it would be interesting to know the exact procedures, which are carried out: When to start after anastomosis or burn? Which examinations are needed before treatment? What is the ideal number of dilatations or is it depending on clinical symptoms or findings during the first treatment? In which diameter-steps? How long should the dilatation take: 20s, 1 min, 2 minutes? With which target diameter? By endoscopists or radiologists? What are the results? What are the complications? How are the complications treated? When changing from therapy, after how many procedures or time?
Alternatively, if bougienage with semi-rigid dilators is performed – do these provide better or worse results than balloon dilatation?
What are the experiences with different stents – self-extending metal stents, custom-made stents, biodegradable stents? What are the risks? Which stents are available and appropriate for the management of esophageal stenosis in children?
Concerning cortisone, no exact specification of administration can be found. Which substances are used? Which amount? Which dilution? In which depth regarding the wall of the stenosis should cortisone be injected? At what intervals? What are the risks of steroid injection? What are the results? Similar questions arise for mitomycin: How to administer safely and effectively? In which dosage? In what intervals? What are the results? As this is potentially carcinogenic, what should be the follow-up?
When should a stenosis, which is refractory to treatment, be operated on? Is resection and anastomosis better than replacement?
Is there a role in children for endoscopic treatment of the stenosis with an endoscopic knife, as used in adults?
Can injection of Botox prevent the development of stenosis?
What is the effect of diet on stenosis, and what is the role of the speech therapist to prevent eating disorders consequent to recurrent stenosis?
We welcome the submission of Original Research, General Commentary, Opinion, Review and Mini Review articles covering, but not limited to, the above aspects of esophageal stenosis in children.
Keywords: Children, esophageal stenosis, refractionary strictures, esophageal atresia esophageal burn, therapy, dilatation, bougienage, stent, cortisone, mitomycin, resection
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.