Clinical application of gastroscopic bougie dilatation in treatment of anastomotic stricture after surgical repair of congenital esophageal atresia and analysis of influencing factors

doi:10.3877/cma.j.issn.1673-5250.2017.03.012

Objective

To evaluate the clinical application and therapeutic effect of gastroscopic bougie dilatation in treatment of anastomotic stricture after surgical repair of congenital esophageal atresia (CEA) and preliminary explore the influencing factors associated with repeated gastroscopic bougie dilatations.

Methods

A total of 25 cases of infants who received gastroscopic bougie dilatation treatment in Chengdu Women′s and Children′s Central Hospital due to anastomotic stricture after surgical repair of CEA were chosen as research subjects. They were divided into group A (n=11, dilatation times≤2 times) and group B (n=14, dilatation times>2 times) according to the times of gastroscopic bougie dilatation. The influencing factors associated with repeated gastroscopic bougie dilatations were analyzed between two groups by statistical methods. Follow-up of survival children were conducted after the last dilatation including diet condition and nutrition status and the follow-up deadline was September 2015. The follow-up results of two groups were statistically analyzed. This study was approved by the Ethical Review Board of Investigation in Human Being of Chengdu Women′s and Children′s Central Hospital. All the parents of the infants signed informed consents. There were no statistically significant differences between two groups in the age, gender ratio and the other basic clinical data (P>0.05).

Results

①As to the 25 children with anastomotic stricture after surgical repair of CEA, the ages of initial gastroscopic bougie dilatation were 27-575 days. All the children received 76 times of successful gastroscopic bougie dilatations and each received an average of 3 times of dilatation. And 2 children had complications including esophageal fistula and esophageal edema, respectively. ②The value of structure index (SI) before the last gastroscopic bougie dilatation in group A was higher than that in group B, while the largest diameter of bougie was lower than that in group B, and both the differences were statistically significant (t=3.829, P=0.002; t=4.263, P<0.001). ③One case of child died with esophageal fistula after the last gastroscopic bougie dilatation. So 24 survival children were enrolled in the follow-up, the longest follow-up time was 42 months and the mean time was 7.4 months. The growth and development of 91.2% (22/24) children were in normal range. Esophageal edema and gastroesophageal reflux were occurred in two children, respectively. All children had no obvious dysphagia and food obstruction symptoms and none of the children received gastroscopic bougie dilatation again at end of follow-up.

Conclusions

Gastroscopic bougie dilatation is effective and safe for the treatment of anastomotic stricture after surgical repair of CEA. Repeated gastroscopic bougie dilatations lead to bigger diameter of esophageal and improvement of dysphagia. As the sample size in this study is relatively small, more large sample, multi-center, randomized controlled clinical trials are required to explore the causes of repeated gastroscopic bougie dilatations in treatment of anastomotic stricture after surgical repair of CEA, and to confirm the exact therapeutic effect of gastroscopic bougie dilatation in treatment of anastomotic stricture after surgical repair of CEA.

Key words: Congenital esophageal atresia, Anastomotic stricture, Bougie dilatation, Gastroscopes, Child

图1 1例月龄为1个月的先天性食管闭锁修补术后吻合口狭窄男性患儿接受胃镜下探条扩张术治疗情况(图1A：胃镜下探条扩张术前；图1B；胃镜下探条扩张术中；图1C：胃镜下探条扩张术后)

表1 2组先天性食管闭锁修补术后吻合口狭窄患儿胃镜下探条扩张术相关因素比较

组别	例数	性别(男/女)	首次扩张术时的年龄[d，M(P₂₅～P₇₅)]	首次扩张术前SI值(±s)	首次扩张术探条使用数[根，M(P₂₅～P₇₅]	首次扩张术探条最大直径[mm，M(P₂₅～P₇₅]	末次扩张术时的年龄(d，±s)	末次扩张术前SI值(±s)	末次扩张术探条使用数[根，±s]
A组	11	5/6	59.0(38.8～201.5)	0.5±0.1	2.0(2.0～2.0)	7.0(7.0～7.5)	226.0±201.6	0.5±0.1	2.2±0.6
B组	14	8/6	53.5(36.5～56.0)	0.7±0.1	1.5(1.0～2.0)	7.0(7.0～7.0)	415.1±282.8	0.4±0.1	1.8±0.8
检验值	?	－	Z＝1.049	t＝0.895	Z＝1.281	Z＝2.038	t＝2.146	t＝3.829	t＝1.344
P值	?	0.272	0.317	0.850	0.277	0.201	0.054	0.002	0.189
组别	例数	末次扩张术探条最大直径(mm, ±s)	首次扩张术前合并吞咽困难症状(n/n′)			末次扩张术前合并吞咽困难症状(n/n′)
组别	例数	末次扩张术探条最大直径(mm, ±s)	无呕吐	进食半流质体食物后呕吐	进食流质体食物后呕吐	无呕吐	进食固体食物后呕吐	进食半流质体食物后呕吐	进食流质体食物后呕吐
A组	11	9.2±1.6	3/11	1/11	7/11	3/11	3/11	2/11	3/11
B组	14	11.9±1.7	4/14	1/14	9/14	7/14	3/14	2/14	2/14
检验值	?	t＝4.263	χ²＝1.461			χ²＝2.063
P值	?	<0.001	0.691			0.457

表1 2组先天性食管闭锁修补术后吻合口狭窄患儿胃镜下探条扩张术相关因素比较

组别	例数	性别(男/女)	首次扩张术时的年龄[d，M(P₂₅～P₇₅)]	首次扩张术前SI值(±s)	首次扩张术探条使用数[根，M(P₂₅～P₇₅]	首次扩张术探条最大直径[mm，M(P₂₅～P₇₅]	末次扩张术时的年龄(d，±s)	末次扩张术前SI值(±s)	末次扩张术探条使用数[根，±s]
A组	11	5/6	59.0(38.8～201.5)	0.5±0.1	2.0(2.0～2.0)	7.0(7.0～7.5)	226.0±201.6	0.5±0.1	2.2±0.6
B组	14	8/6	53.5(36.5～56.0)	0.7±0.1	1.5(1.0～2.0)	7.0(7.0～7.0)	415.1±282.8	0.4±0.1	1.8±0.8
检验值	?	－	Z＝1.049	t＝0.895	Z＝1.281	Z＝2.038	t＝2.146	t＝3.829	t＝1.344
P值	?	0.272	0.317	0.850	0.277	0.201	0.054	0.002	0.189
组别	例数	末次扩张术探条最大直径(mm, ±s)	首次扩张术前合并吞咽困难症状(n/n′)			末次扩张术前合并吞咽困难症状(n/n′)
组别	例数	末次扩张术探条最大直径(mm, ±s)	无呕吐	进食半流质体食物后呕吐	进食流质体食物后呕吐	无呕吐	进食固体食物后呕吐	进食半流质体食物后呕吐	进食流质体食物后呕吐
A组	11	9.2±1.6	3/11	1/11	7/11	3/11	3/11	2/11	3/11
B组	14	11.9±1.7	4/14	1/14	9/14	7/14	3/14	2/14	2/14
检验值	?	t＝4.263	χ²＝1.461			χ²＝2.063
P值	?	<0.001	0.691			0.457

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