Esophageal stenting in children: indications, application, effectiveness, and complications

Background: Use of esophageal stents is uncommon in children, and there are few reports. We report the first experience in predominantly small children and infants with retrievable, flexible stents designed for tracheobronchial use. Objective: Evaluation of initial experience with placement of esophageal stents for benign esophageal disorders in children. Design: A retrospective study. Setting: A pediatric, academic, tertiary-referral center. Patients: This study involved 7 pediatric patients. Interventions: Covered tracheobronchial stents were endoscopically placed in pediatric patients with benign esophageal conditions. Removal involved using forceps to pull the purse-string suture into the endoscope channel and collapsing the top of the stent for easy removal. Main Outcome Measurements: To evaluate the safety and feasibility of performing endoscopic stent placement in children and to establish criteria for early stent removal. Results: Six of 7 patients benefitted from stenting. There were no complications of placement. Novel techniques were developed for difficult retrievals. One patient did not benefit from esophageal stent placement, because the stent migrated downward from the uppermost part of the esophagus. One patient had some gagging, which led to early removal of the stent. A stent was removed emergently in 1 patient for respiratory distress. Limitation: Small number of patients. Conclusions: Retrievable, covered stents are easily placed and removed from the esophagus in small children. They should be considered for severe unrelenting strictures, especially when associated with esophageal leaks. A need exists for development of esophageal stents designed for pediatric use.