ESOPHAGEAL PEPTIC STENOSIS: MANAGEMENT OF A COMPLEX CASE

Introduction: esophageal stenosis is one of the most serious problems in patients with peptic esophagitis. It may require esophageal resection and replacement, if no other treatment is effective. Patients and methods: we report a successfully managed case of persistent esophageal stricture. The patient was a 10-year-old boy suffering from gastroesophageal reflux since birth. He has an esophageal peptic stricture which was treated with multiple dilatation at another hospital (about 24 times). The boy joined our Unit for gastroesophageal reflux and severe esophageal stricture confirmed with contrast X-ray. He could only eat liquid foods and had a growth retardation. He underwent endoscopy which shows severe esophagitis with mucosal bleeding. He also had a severe anemia, for which he underwent blood transfusion. We decided to submit the boy to Toupet laparoscopic fundoplication, endoscopic intraluminal dilatation with balloon and diathermic needle and therapy with PPI (protonic pump inhibitors) and corticostheroids. The little patient needed 7 endoscopic dilatations. Results: one month after the last dilatation he has grown, can eat all kind of foods, his blood count is normal and X-ray and endoscopy both show resolution of the stenosis and esophagitis. Conclusions: we report this case because we think that it’s a complex and interesting case. This patient was a candidate for esophageal replacement. We managed to save his native esophagus, treating gastroesophageal reflux and peptic stenosis with surgery and endoscopic dilatations, and reducing fibrosis and scarring with corticosteroid therapy. We thus think that this therapeutic procedure can be an optimal choice to contemplate before considering native esophagus replacement.