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Background and Purpose:Serious treatment-induced esophageal strictures and t racheoesophageal fistulae are rare in the pediatric oncology population.This re port details our experience with their management.Methods:We retrospectively r eviewed our experience with pediatric oncology patients treated for esophageal c omplications over a 23-year period.Serious complications were defined as devel opment of strictures requiring dilatation or an esophageal fistula.Fifteen pati ents were identified,5 of which had been previously reported.Results:Thirteen patients developed esophageal stricture,and 2 progressed to tracheoesophageal fistulae.The remaining 2 patients developed tracheoesophageal fistulae without antecedent stricture.The median interval from cancer diagnosis until developmen t of esophageal complications was 3.5 years(range,0.4-11.8 years).Before dev elopment of esophageal complication,14 patients(93%)were treated with medias tinal radiation and 7(47%)for candidal esophagitis.Strictures were most comm only located in the distal esophagus(5),then midesophagus(3),cervical esopha gus(3)and diffusely(2).A median of 5 dilatations(range,1-50)were necessa ry before patients were able to resume a normal diet.The origin of tracheoesoph ageal fistulae was the midesophagus(3)and distal esophagus(1).All 4 patients with fistulae were treated with esophageal division and diversion followed by e sophagocoloplasty.Conclusions:Esophageal strictures and fistulae may occur bec ause of cancer therapy in childhood.Prevention includes early treatment of esop hagitis especially Candida mucositis,and minimization of radiation dose to the esophagus.Strictures usually respond to dilatation,but fistulae require esopha geal diversion and secondary reconstruction.
Background and Purpose: Serious treatment-induced esophageal strictures and t racheoesophageal fistulae are rare in the pediatric oncology population. This re port details our experience with their management. Methods: We retrospectively r eviewed our experience with pediatric oncology patients treated for esophageal c omplications over a 23-year period. Serious complications were defined as devel opment of strictures requiring dilatation or an esophageal fistula. Fifteen patints were identified, 5 of which had been previously reported. Results: Thirteen patients developed esophageal stricture, and 2 progressed to tracheoesophageal fistulae . Remaining 2 patients developed tracheoesophageal fistulae without antecedent stricture. The median interval from cancer diagnosis until developmen t of esophageal complications was 3.5 years (range, 0.4-11.8 years) .Before dev elopment of esophageal complication, 14 patients (93%) were treated with medias tinal radiation and 7 (47%) for candidal esophagitis.Stri ctures were most comm only located in the distal esophagus (5), then midesophagus (3), cervical esopha gus (3) and diffusely (2). A median of 5 dilatations (range, 1-50) were necessa ry before patients were able to resume a normal diet. The origin of tracheoesoph ageal fistulae was the midesophagus (3) and distal esophagus (1) .All 4 patients with fistulae were treated with esophageal division and diversion followed by e sophagocoloplasty. Conclusions: Esophageal strictures and fistulae may Prevention bec ause of cancer therapy in childhood. Prevention includes early treatment of esop hagitis especially Candida mucositis, and minimization of radiation dose to the esophagus. strict signals usually respond to dilatation, but fistulae require esopha geal diversion and secondary reconstruction.