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Treatment of isolated and recurrent tracheoesophageal fistula in children: a case series and literature review

World Journal of Pediatric Surgery 2021年第4期4卷 52-56页

作者： Aleh Sautin Kiryl Marakhouski Aleh Pataleta Aliaksandr Svirsky Vasili Averyn Diagnostic Division Republican Scientific and Practical Center of Pediatric SurgeryMinskBelarus Department of Pediatric Surgery Republican Scientific and Practical Center of Pediatric SurgeryMinskBelarus Department of Pediatric Surgery Belarusian State Medical UniversityMinskBelarus

Background Despite improvements in the treatment of esophageal atresia with tracheoesophageal fistula(TEF)in recent decades,complications still exist.The rate of fistula recanalization after surgical repair is~5%in large cohorts.However,there is controversy regarding the gold standard of treatment.This research aimed to evaluate the efficacy of treatment of pediatric patients with isolated(H-type)and recurrent TEF in our clinic.Methods We retrospectively analyzed 12 patients(7 boys,5 girls)aged 35 days-14.6 years.The median age of our patients was 632 days[95%CI(confident interval)120.1 to 2118.7];the mean birth weight was 2713 g(95%CI 2258 to 3169;median:2763 g);and the mean gestational age was 37.1 weeks(95%CI 35.4 to 38.8;median:37 weeks).All patients were managed for isolated or recurrent TEF between January 1,2015 and December 31,2020 using endoscopy(laser de-epithelialization).Results Laser de-epithelialization alone was effective in 8 of 12 patients(66.67%),with a mean number of de-epithelializations of 2.25(range:1-4).After one attempt at de-epithelialization,success was achieved in only two patients(n=16.67%).The mortality rate was 0%.The median follow-up for patients who received endoscopic treatment exclusively(n=8)was 3.7 years(95%CI 1.38 to 4.87)after the last stage of de-epithelialization.Conclusion Flexible endoscopy is an alternative treatment to open surgical repair of isolated and recurrent TEF in children.The effectiveness of endoscopic laser de-epithelialization alone with subsequent fistula obliteration was 66.7%,with a median follow-up of 3.7 years.

关键词： fistula mortality alone

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Gastroesophageal reflux disease in pediatric esophageal atresia:Assessment of clinical symptoms and pH-impedance data

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World Journal of Clinical Pediatrics 2020年第2期9卷 29-43页

作者： Marina Aksionchyk Kirill Marakhouski Aliaksandr Svirsky Department of Pediatric Gastroenterology Diagnostic DivisionRepublican Scientific and Practical Center for Pediatric SurgeryMinsk 220013Belarus Department of Endoscopy Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus Department of Pediatric surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus

BACKGROUND Esophageal atresia(EA)is the most common congenital anomaly of the gastrointestinal tract.Gastroesophageal reflux disease(GERD)is a frequent and lifelong problem in these patients.GERD can be asymptomatic and the incidence of esophageal gastric and intestinal metaplasia(Barrett’s esophagus)is increased in adults with EA compared with the general population.Timely and accurate diagnosis of GERD is important to reduce long-term problems and this may be achieved by pH-impedance testing.AIM To assess symptoms and pH-impedance data in children after EA,in order to identify their specific features of GERD.METHODS This study was conducted from November 2017 to February 2020 and involved 37 children who had undergone EA via open surgical repair(51.35%boys,48.65%girls;age range:1-14 years,median:4.99 years).GERD diagnosis was made based on multichannel intraluminal impedance/pH study and two groups were established:EA without GERD,n=17;EA with GERD,n=20.A control group was established with 66 children with proven GERD(68.18%boys,31.82%girls;median age:7.21 years),composed of a nonerosive reflux disease(referred to as NERD)group(n=41)and a reflux esophagitis group(n=25).Upper gastrointestinal endoscopy with a mucosal esophageal biopsy was performed on all patients.RESULTS The most frequently observed symptom in EA patients with GERD and without GERD was cough(70%and 76.5%respectively).The number of patients with positive symptom association probability in the EA groups was significantly larger in the EA without GERD group(P=0.03).In the control reflux esophagitis group,prevalence of gastrointestinal symptoms was significantly higher than in the NERD group(P=0.017).For both EA groups,there was strong correlation with index of proximal events(IPE)and total proximal events(EA with GERD:0.96,P<0.001;EA without GERD:0.97,P<0.001)but level of IPE was significantly lower than in GERD patients without any surgical treatment(P<0.001).Data on distal mean nocturnal baseline impedance were significantly different between th

关键词： Esophageal atresia Gastroesophageal reflux disease pH-impedance testing Mean nocturnal baseline impedance Proximal reflux Reflux esophagitis Nonerosive reflux disease Pediatric

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Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 343-349页

作者： Kirill Marakhouski Elena Malyshka Katsiaryna Nikalayeva Larysa Valiok Aleh Pataleta Kiryl Sanfirau Aliaksandr Svirsky Vasily Averin Division of Diagnostic Republican Scientific and Practical Centre of Paediatric SurgeryMinsk 220113Belarus Department of Newborn Surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus Department of Pediatric Surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus Division of Diagnostic Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus Academic Chair of Pediatric Surgery Belarusian State Medical UniversityMinsk 220116Belarus

BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To present our experience of balloon dilatation of a perforated duodenal memb-rane in newborns with ICDO.METHODS Five newborns who underwent balloon dilatation of the CPDW along a prein-stalled guidewire between 2021 and 2023 were included.Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group.RESULTS In all cases,good anatomical and clinical results were obtained.In three cases,a follow-up study was conducted after 1 year.The average time to start enteral feeding per os was significantly earlier in the study group(4.4 d)than in the laparotomic group(21.2 days;P<0.0001).The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter.We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows:(1)Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web;(2)presence of endoscopic signs of CPDW;(3)successful cannulation with a guidewire performed parallel to the endoscope,with holes in the congenital duodenal web;and(4)successful positioning of the balloon performed along a freestanding guidewire on the web.CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.

关键词： Newborns Congenital duodenal obstruction Perforated duodenal membrane Endoscopy Balloon dilation

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Endoscopic treatment of blue rubber bleb nevus syndrome in a 4-year-old girl with long-term follow-up:A case report

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World Journal of Gastrointestinal Endoscopy 2021年第3期13卷 90-96页

作者： Kirill Marakhouski Elena Sharafanovich Uladzislau Kolbik Aleh Sautin Katsiaryna Nikalayeva Aleh Pataleta Kiryl Sanfirau Aliaksandr Svirsky Diagnostic Division Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220113Belarus Department of Elective Surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220113Belarus Department of Pediatric Surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus

BACKGROUND Blue rubber bleb nevus syndrome(BRBNS)is a rare vascular disease,difficult to diagnose and choose a treatment method,especially in young children.There are several limiting factors to the use of enteroscopy for diagnostics and treatment in pediatric patients,in general.The literature on BRBNS cases is limited and presents various therapeutic approaches.CASE SUMMARY We present here a case of BRBNS involving a 4-year-old female,whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam.Skin lesions,typical for BRBNS,appeared on the 8th d of the child’s life and their number increased over the next several months.The child also experienced episodes of critical decrease in hemoglobin level(by as much as 52 g/L)for several years,requiring iron supplementation and several blood transfusions.Video capsule endoscopy revealed numerous vascular formations in the small bowel.The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis.Single-balloon enteroscopy was used to perform sclerotherapy,with aethoxysklerol foam.A positive effect was observed within 19 mo of follow-up.We continue to monitor the patient’s hemoglobin level,every 2 wk,and it has remained satisfactory(>120 g/L).CONCLUSION Endoscopic sclerotherapy can be effective in the clinical management of gastrointestinal manifestations of BRBNS in young children.

关键词： Blue rubber bleb nevus syndrome Bean syndrome Single-balloon enteroscopy Children Vascular malformations Gastrointestinal tract Sclerotherapy Aethoxysklerol foam Case report

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