IDDF2026-ABS-0177 Dynamic esophageal stenting with a modified ryle’s tube reduces dilatation burden in children with refractory corrosive strictures

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Background Corrosive substance ingestion leading to severe esophageal strictures remains a significant public health problem, particularly among children in developing countries. These patients often require repeated endoscopic dilatations, which impose substantial physical, emotional, and financial burden on families. Dynamic esophageal stenting using a modified Ryle’s tube represents a novel, low-cost strategy aimed at reducing the need for repeated dilatations. The custom dynamic stent promotes gradual luminal expansion through continuous dynamic dilatation. This study aimed to describe the technique, safety, and long-term outcomes of dynamic esophageal stenting using a modified nasogastric tube in children with refractory esophageal strictures. Methods A custom dynamic stent was constructed by placing a 30 Fr silicone drain tube slice coaxially over a 16 Fr Ryle’s tube and securing its ends with silk sutures (IDDF2026-ABS-0177 Figure 1. Components required to construct custom dynamic stent. Images (A) 14 Fr Ryle’s tube with 2-0 silk suture. (B) Silicon chest drain with sliced segment. (C) excised segment mounted over Ryle’s tube and secured using sutures). The ends were tailored to permit the passage of food boluses between the stent and esophageal wall. The modified Ryle’s tube was inserted endoscopically, with the stent positioned across the stricture site (IDDF2026-ABS-0177 Figure 2. Esophageal lumen showing corrosive stricture (Image A), placement of custom stent across the stricture (Image B). Post-stent removal, ulceration noted at the site of the stent (Image C), which resolved on follow-up (Image D) with maintained luminal patency). Post-procedure, patients received dexamethasone (2 mg/kg/day) for three days along with proton pump inhibitors. Oral feeding was initiated, and the stent was maintained in-situ for 40 days. Institutional ethics committee approval was obtained. Results Seven children (mean age 3.2 years) underwent dynamic esophageal stenting. The stent remained in place for a median duration of 31 days (IQR 30–40). Prior to stenting, patients required frequent endoscopic dilatations with a median of 14 sessions (IQR 10–15). Following stent placement, the number of dilatations significantly decreased to a median of 4 sessions (IQR 4–5) (p = 0.022). Additionally, the interval between successive dilatations increased from a median of 4 weeks (IQR 3–4) before stenting to 12 weeks (IQR 10–12) after stenting (p = 0.022) (IDDF2026-ABS-0177 Figure 3. Violin Plot with embedded box-and-whisker representation comparing pre- and post-stenting reduction in dilatation sessions. (Wilcoxan, p=0.22)). Conclusions Custom dynamic esophageal stenting using a modified Ryle’s tube is a safe, low-cost, and effective technique that significantly reduces the dilatation burden and prolongs the symptom-free interval in children with refractory esophageal strictures.

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