OBJECTIVE:Nutritional therapy is a cornerstone for the induction of remission in pediatric Crohn's disease (CD); however, the optimal dietary strategy remains uncertain. This study aimed to compare the short- and long-term therapeutic outcomes of exclusive enteral nutrition (EEN) and the Crohn's disease exclusion diet (CDED) in a large cohort of children with CD. METHODS:This historical cohort study included children diagnosed with CD between 2014 and 2023 who were treated exclusively with either EEN or the CDED for the induction of disease remission. Demographic, clinical, and laboratory data were collected over a 52-week follow-up period. RESULTS:A total of 159 patients were included: 75 treated with EEN and 84 with the CDED. Baseline demographic and disease characteristics were comparable between groups. At 6 weeks, clinical remission was achieved in 58 (77%) children in the EEN group and 63 (75%) children in the CDED group (p = 0.730). Treatment adherence rates were similarly high (EEN 89% vs. CDED 88%, p = 0.810). Week 6 normalization of C-reactive protein (EEN 43% vs. CDED 46%, p = 0.709) and fecal calprotectin <150 mcg/g (EEN 35% vs. CDED 34%, p = 0.982) were also comparable between the groups. A Mucosal Inflammation Noninvasive index score <8 was documented in 52% versus 69% of the groups, respectively (p = 0.219). There were no group differences in rates of disease exacerbation, corticosteroid or biologic therapy use, hospitalizations, or need for surgery during 52 weeks of follow-up. CONCLUSIONS:EEN and the CDED demonstrated no significant differences in efficacy across all assessed clinical and biochemical outcomes throughout the 52-week follow-up period.
OBJECTIVES:Despite advances in pediatric inflammatory bowel disease (PIBD) with biologics, remission rates remain at 47%-60% with loss-of-response rates at 60%-68%. Evidence for efficacy of dual biologic therapy (DBT) with anti-tumor necrosis factor alpha therapy (anti-TNF-α)- vedolizumab (VDZ) for children refractory to anti-TNF-α therapy is limited. This study aimed to describe rates of steroid-free clinical remission (CR), endoscopic and histological remission, trends in biochemistry, predictors of response, and adverse events in this population. METHODS:We performed a retrospective study of children with PIBD treated with anti-TNF-α-VDZ DBT for 6-12 months from 2020 to 2023. RESULTS:Twenty-two treatment episodes were analyzed in 21 patients (17 Crohn's disease, 5 ulcerative colitis) with 13 continuing to 12 months. CR increased from 9% at baseline to 68% at 3 months (95% confidence interval [CI] 47%-83%, p < 0.01), 55% at 6 months (95% CI 35%-73%, p < 0.05) and 50% at 12 months (95% CI 31%-69%, p < 0.05). Seventy-two percent in total achieved CR during follow-up. Endoscopic remission increased from 5% to 38% (p = 0.02), histological remission from 5% to 29% (p = 0.046). Fecal calprotectin decreased from 930 to 500 μg/g at 3 months (p = 0.04), 680 μg/g at 6 months (p = 0.03), and 255 μg/g at 12 months (p = 0.12). Trends toward remission were observed in patients with colonic disease, incomplete response rather than loss of response to anti-TNF-α, and ulcerative colitis. Two significant adverse events occurred: pulmonary mucormycosis and herpes-simplex virus keratitis. CONCLUSION:Anti-TNF-α-VDZ DBT improved clinical, endoscopic, and histological outcomes in children refractory to biologic monotherapy.
OBJECTIVES:The hepatology committee of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) aims to provide education on key aspects of paediatric hepatology. Here we provide recent developments in the understanding, diagnosis and clinical consequences of portal hypertension (PHT) in children and young people, an area in which evidence remains scarce and fragmented. METHODS:In 2024, an EPSGHAN 3-day monothematic conference on paediatric PHT, held in Dublin (Ireland), brought together international experts in PHT. The first sessions of the conference were dedicated to PHT classification, pathophysiology, epidemiology, diagnostic dilemmas and major complications. Lectures have been integrated to provide an up-to-date overview of clinical practice. RESULTS:Opening sessions addressed the definition and classification of paediatric PHT, highlighting key differences between cirrhotic and non-cirrhotic causes. Advances in diagnostic imaging, the role of non-invasive tests and biopsy limitations are reviewed. Subsequent discussions focused on the mechanisms and management of major complications, including renal impairment, encephalopathy, cardiopulmonary dysfunction and endocrine consequences. Nutritional challenges and the interaction between PHT and gut-liver axis were emphasised as possible determinants of outcomes. CONCLUSIONS:This report summarises the key learning points of the first part of the meeting. These discussions set the foundation for defining research priorities and improving early recognition and multidisciplinary care strategies.
OBJECTIVE:To summarise current evidence and expert perspectives on the management of paediatric portal hypertension, primarily focusing on portal hypertensive varices and gastrointestinal bleeding in children, as discussed during the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) monothematic conference meeting on portal hypertension. METHODS:In 2024, an EPSGHAN 3-day monothematic conference on paediatric portal hypertension was held in Dublin (Ireland), gathering international experts in portal hypertension. The second part of the meeting focused on clinical algorithms for acute variceal bleeding, minimally invasive radiological treatments, surgical shunts, and indications for liver transplantation. Additional sessions examined methodological constraints affecting paediatric clinical trials, supported by case-based discussions and expert panel debates. RESULTS:Faculty outlined updated approaches to emergency management for upper gastrointestinal bleeding, including stabilisation, pharmacotherapy and endoscopy treatment. Minimally invasive radiological procedures and surgical treatments were reviewed. Sessions highlighted indications for transplantation and management of post-transplant portal vein thrombosis. Presentations on registries underscored their value in rare diseases. The final session detailed the statistical, ethical and logistical challenges inherent in paediatric clinical trials and specific challenges in portal hypertension trials. CONCLUSIONS:Current management strategies across medical, endoscopic, radiological and surgical fields were reviewed, recognising the scarcity of paediatric-specific evidence. Enhanced collaboration, harmonised registries, and standardised study designs were identified as vital next steps towards optimising outcomes in children with portal hypertension.
Necrotizing enterocolitis (NEC) remains a major cause of morbidity and mortality in very low birth weight infants, while the safest rate of enteral feed advancement remains debated. We performed a retrospective single-center before-after cohort study in a tertiary neonatal intensive care unit, comparing two feeding strategies in 572 infants (286 per group): faster advancement (20-30 mL/kg/day) from 2015-2018 and slower advancement (10-25 mL/kg every 48 h, weight-dependent) from 2020-2023. The primary outcome was NEC, defined as Bell stage ≥IIb or diagnosis at surgery. NEC was less frequent in the slower-advancement era (2.1% vs 7.9%; adjusted p = 0.02). Mortality, late-onset sepsis, central venous catheter duration, and extrauterine growth restriction were similar. Faster advancement led to earlier full enteral feeding, while discharge weight centiles were comparable. A cautious feeding strategy was associated with lower NEC incidence without evidence of worse infectious or growth outcomes.
OBJECTIVES:Anaemia impairs daily activities and quality of life in patients with paediatric-onset inflammatory bowel disease (PIBD). This study aimed to investigate the prevalence of anaemia at PIBD-diagnosis and the following 5 years. Furthermore, anaemia subtypes and the association between anaemia and disease activity were assessed over time. METHODS:Patients (6-17 years) diagnosed with PIBD between 2014 and 2022 were identified from Danish national health registers. Anaemia was defined according to the World Health Organization criteria. Anaemia subtypes (iron deficiency anaemia [IDA], anaemia of chronic disease [ACD], and IDA + ACD) were classified using guidelines by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition. PIBD disease activity was based on medication, surgeries, and hospitalisation. RESULTS:Of 1266 incident patients with PIBD, 660 (52%) were anaemic at diagnosis, decreasing to 25% in year 5. Moderate anaemia was most frequent at diagnosis and in the first year, while mild anaemia was more frequent in the following years. Of patients with anaemia at diagnosis, 237 were assigned a subtype; 25 (11%) presented with IDA, 44 (19%) with ACD, and 168 (71%) with IDA + ACD. Anaemia was associated with disease activity during the 5 years following PIBD-diagnosis with a peak association in year 4 (adjusted risk ratio: 2.3; 95% confidence interval [CI]: 1.8-3.0). CONCLUSIONS:Anaemia was common at PIBD-diagnosis and, although the prevalence decreased over time, especially mild anaemia, remained frequent. IDA + ACD was the most common subtype at diagnosis and disease activity was associated with anaemia.
OBJECTIVES:Corrosive substance ingestion remains a significant pediatric emergency, particularly in developing countries. This study aims to evaluate the clinical characteristics of pediatric patients hospitalized for corrosive ingestion and assess the necessity of routine esophagoscopy in their diagnostic workup. METHODS:A retrospective review was conducted of 230 patients aged 0-18 years admitted between 2010 and 2020. Demographic data, clinical findings, type and amount of corrosive substance, and management approach (conservative vs. endoscopic) were analyzed. Esophageal burn presence and grade were recorded using Zargar's classification. Outcomes included oral feeding tolerance, hospital stay duration, and development of strictures. RESULTS:Among 230 patients, 73% underwent diagnostic esophagoscopy, and 69.6% of them had mucosal burns, mostly in the upper esophagus. Vomiting was the most frequent symptom (33.6%), while oropharyngeal hyperemia was the most common physical sign (30.8%). Notably, 24% of patients were both asymptomatic and had normal physical exams. Esophageal burns correlated with larger ingestion volumes and prolonged hospitalization and oral feeding initiation (p < 0.05). Seventeen patients (7%) developed esophageal strictures, predominantly among those with Grade 2A or higher burns. Physical examination findings, especially visible oropharyngeal lesions, were more predictive of mucosal injury than isolated symptoms. CONCLUSION:Routine esophagoscopy in asymptomatic pediatric patients without pathological findings may be unnecessary. Clinical decision-making should prioritize symptom severity, ingestion history, and physical examination. These findings support a selective, individualized approach to endoscopy, aiming to reduce unnecessary procedures while ensuring timely identification of high-risk cases.
OBJECTIVES:Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease with rising incidence globally. Described predominantly in White populations, the clinical features of EoE in Hispanic children are poorly characterized. This study evaluated the clinical, endoscopic, histologic, and treatment characteristics of Hispanic versus Non-Hispanic pediatric patients with EoE. METHODS:We conducted a retrospective comparative cohort study of pediatric patients newly diagnosed with EoE. Hispanic patients were compared 1:1 with non-Hispanic. Clinical, atopic, endoscopic, histologic, and treatment data were abstracted from medical records. Multivariate logistic regression identified features associated with Hispanic ethnicity. RESULTS:One hundred and eighty-six patients (93 Hispanic, 93 non-Hispanic) were included. Hispanic patients had longer symptom duration before diagnosis, were more likely to present with weight loss (odds ratio [OR] 10.16, 95% confidence interval [CI] 3.00-34.41) and asthma (OR 3.7, 95% CI 1.28-10.66), and less likely to have immunoglobulin E-mediated food allergy (OR 0.07, 95% CI 0.02-0.23). Endoscopically, they were more likely to have a normal-appearing esophagus (OR 21.07, 95% CI 3.47-127.83) with fewer furrows; however, when abnormal endoscopic findings were present, exudates were more common (OR 3.3, 95% CI 1.06-10.28). Histologic activity was comparable across groups. Treatment responses were similar overall, though remission with proton pump inhibitors was more common in Hispanic patients. CONCLUSIONS:Hispanic pediatric patients with EoE exhibit distinct clinical features, which may reflect differences in clinical presentation and healthcare-related factors that were not directly measured. These observations underscore the need for heightened clinical awareness and tailored strategies to reduce disparities in diagnosis and access to care among Hispanic patients.
OBJECTIVES:This study aimed to evaluate correlations between transmural inflammation assessed by cross-sectional imaging and endoscopic activity in pediatric Crohn's disease (CD) at diagnosis. METHODS:We retrospectively reviewed data of patients with CD referred to our Pediatric Gastroenterology Unit who underwent ileocolonoscopy, intestinal ultrasound scan, and magnetic resonance enterography (MRE) at diagnosis. The Simplified Endoscopic Score for Crohn's disease (SES-CD) was routinely reported, as per protocol at our institution. Two independent reviewers, blinded to the endoscopic findings, retrospectively calculated the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) and the Pediatric Inflammatory Crohn's Magnetic Resonance Enterography Index (PICMI). Correlations were evaluated using Spearman's rho (ρ). RESULTS:Sixty-seven patients were identified (61.2% males, median age at diagnosis 12.9 years [interquartile range, IQR 10.5-14.9]). Forty-four (65.6%) had ileocolonic disease. While IBUS-SAS showed a positive correlation with PICMI (ρ = 0.377, p = 0.002), SES-CD did not correlate with either PICMI (ρ = 0.101, p = 0.420) or with IBUS-SAS (ρ = 0.003, p = 0.982). SES-CD showed a positive correlation with IBUS-SAS (ρ = 0.810, p < 0.001) and PICMI (ρ = 0.402, p = 0.001) only when calculated for the terminal ileum (TI). MRE failed to identify superficial colonic lesions in 26/47 patients (55.3%) with L2 or L3 disease phenotype. The median SES-CD was significantly higher in patients with detectable colonic disease by MRE compared with those without detectable colonic disease (20 vs. 16; p = 0.042). CONCLUSIONS:In our cohort, the correlation between endoscopic and cross-sectional imaging scores differed according to disease location, with significant associations observed for TI involvement but not for colonic disease.
Hepatitis B virus (HBV) infection remains a global health challenge, with more than 250 million people chronically infected worldwide and >2000 daily deaths from HBV-related disease. Early-life acquisition is the primary driver of chronic infection; up to 90% of infants infected perinatally progress to chronic HBV infection compared with markedly lower rates in older children and adults. Universal infant immunization, including the birth-dose, has been central to global elimination, resulting in a substantial reduction in chronic HBV infection, cirrhosis, and hepatocellular carcinoma. Recent statements from the Centers for Disease Control and Prevention question the evidence-base for early-life vaccination and recommend deferring HBV immunization until later in childhood. These claims reflect misconceptions about HBV epidemiology and reference a perceived association between infant vaccination and autism. This communication summarizes evidence demonstrating the risks of early-life HBV transmission leading to chronic infection. We argue that delaying or foregoing immunization would leave infants at unnecessary risk. We reference two decades of research in which large-scale studies have not identified an association between vaccination, including HBV vaccination, and autism.
OBJECTIVES:Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in children, and practical screening approaches are needed in populations with overweight/obesity. We aimed to evaluate mid-upper arm circumference (MUAC) as a simple marker for ultrasonography (US)-detected liver steatosis (LS) in children with overweight/obesity, to examine the performance of other non-invasive measures, and to assess MUAC-based composite cut-offs. METHODS:In this study, 194 children with overweight/obesity aged 5-17 years were evaluated at a pediatric gastroenterology clinic. US-detected LS was defined as US grade ≥1. Liver stiffness was measured by two-dimensional shear-wave elastography (2D-SWE). Fasting biochemistry was obtained, and alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio, Hepatic Steatosis Index, and Framingham Steatosis Index were calculated. Associations between US-detected LS and anthropometric, biochemical, and liver stiffness measures were assessed using Spearman correlation, logistic regression, and receiver operating characteristic analyses; composite models used an odds ratio-rule approach. RESULTS:US-detected LS was present in 55.2%. MUAC ≥ 30.0 cm yielded an area under the curve (AUC) of 0.738 for identifying US-detected LS. A composite rule of body mass index (BMI) z score ≥1.70 or MUAC ≥ 30.0 cm achieved 97.2% sensitivity and 54.0% specificity for identifying US-detected LS, with an AUC of 0.813, negative predictive value 94.0%, and positive predictive value 72.2%. Adding liver stiffness ≥5.68 kPa increased discrimination for identifying US-detected LS, with an AUC of 0.881. CONCLUSION:MUAC is a low-cost adjunct for screening US-detected LS in children with overweight/obesity. Simple composite cut-offs integrating MUAC with BMI showed high sensitivity in this cohort and may support initial risk stratification before ultrasonographic evaluation; adding liver stiffness yielded the highest discriminative performance.
OBJECTIVE:Very low birth weight (VLBW) preterm infants are at increased risk of neurodevelopmental impairment. Although human milk may promote brain development, the association between type of feeding at discharge and neurodevelopmental outcomes remains uncertain. This study evaluated neurodevelopment at 12 months' corrected age according to type of feeding at discharge in VLBW infants. METHODS:This prospective single-center study included 40 VLBW infants (GA < 32 weeks) born at the University Hospital of Parma. Type of feeding at discharge was classified as exclusive human milk, formula feeding or mixed feeding. Neurodevelopment was assessed at 12 months' corrected age using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), evaluating cognitive, motor, language, socioemotional and adaptive behaviour domains. Time of full enteral feeding achievement and duration of parenteral nutrition were analyzed as continuous variables. Correlation and ANOVA analyses were performed. RESULTS:Type of feeding at discharge was not significantly associated with neurodevelopmental scores. Earlier achievement of enteral nutrition was associated with better cognitive, motor, and language outcomes, while longer duration of parenteral nutrition was associated with lower motor and language scores (p < 0.05). CONCLUSIONS:In VLBW infants, type of feeding at discharge was not associated with neurodevelopmental outcomes at 12 months' corrected age. However, shorter time to full enteral feeding and shorter duration of parenteral nutrition were associated with more favorable neurodevelopmental performance, particularly in motor and language domains. These findings support the importance of optimizing early nutritional management and warrant confirmation in larger prospective studies.
OBJECTIVE:This study investigated the associations between dietary behaviors and gut microbiota in children with autism spectrum disorder (ASD) stratified according to symptom severity, aiming to provide evidence for targeted interventions. METHODS:A cross-sectional study enrolled 81 children with ASD aged 3-12 years, divided into mild-to-moderate (n = 35) and severe (n = 46) groups based on Childhood Autism Rating Scale scores. Dietary behaviors were assessed using the Children's Eating Behavior Questionnaire. Gut microbiota was analyzed by 16S rRNA (16S ribosomal RNA) gene sequencing. Spearman correlation examined associations. RESULTS:The severe ASD group showed significantly lower Enjoyment of Food scores and higher scores for both Emotional Undereating and Emotional Overeating (p < 0.05). Alpha diversity (Shannon and Simpson indices) was significantly lower in the severe group (p < 0.05). Beta diversity showed significant between-group separation (p < 0.05). The severe group exhibited decreased Firmicutes and increased Proteobacteria at the phylum level, with decreased Faecalibacterium and Dialister and a 2.8-fold increase in Klebsiella at the genus level (p < 0.05). Correlation analysis revealed severity-dependent associations: mild-to-moderate ASD showed phylum-level associations, while severe ASD showed genus-level associations. CONCLUSION:Children with severe ASD exhibited more pronounced dietary behavior abnormalities and gut microbiota dysbiosis. The severity-dependent associations suggest stratified intervention strategies for ASD children.
OBJECTIVES:Pancreatic fluid collections (PFCs), either pseudocysts or walled-off necrosis, are a significant cause of morbidity in pediatric patients with acute pancreatitis, leading to pain, obstruction, or infection. Endoscopic ultrasound (EUS)-guided drainage of symptomatic PFCs is the recommended therapy in adult patients and is accomplished using either lumen-apposed metal stents (LAMS) or double pigtail plastic stents (DPPS). Their comparative outcomes in children remain unstudied. METHODS:We performed a retrospective case series of all EUS-guided drainage of symptomatic PFCs among pediatric patients (<21 years) at a freestanding children's hospital over 12 years. We recorded patient demographics, procedural details, and PFC classifications, and summarized these using descriptive statistics. Outcomes included anesthesia time, intra-procedural radiation exposure, time to enteral feeding, stent dwell time, length of stay, and adverse events. RESULTS:Twenty-five unique patients underwent 27 total procedures with attempted transluminal stent placement. Clinical success was achieved in 96.3%. The median age was 10 years (interquartile range [IQR] 5-19), with a median weight of 28.7 kg (21.9-45.4). Of those who underwent stent placement, asparaginase-induced pancreatitis was the leading cause of PFCs (56%), followed by trauma (30%). Among the attempted stent placements, 9/27 (33%) were DPPS and 18/27 (67%) were LAMS. Eighty-one percent were placed trans-gastrically. Patients in the LAMS group had shorter anesthesia time when adjusting for concurrent procedures (p = 0.03) and lower intra-procedural radiation exposure (p = 0.01). Five total adverse events occurred, with no difference between groups (p = 0.27). CONCLUSION:Endoscopic drainage is a safe and effective strategy for the management of symptomatic pediatric PFCs, with high clinical success for both DPPS and LAMS approaches. Further studies are needed to better understand rates of adverse events.
OBJECTIVES:The experience of childhood stressful or adverse life events is believed to imprint on immunological pathways and, therefore, might have lasting effects on inflammatory bowel disease (IBD) development. This study aimed to examine the association between experiences of early-life adverse events and later IBD risk. METHODS:We followed children in the Norwegian Mother, Father, and Child Cohort Study (MoBa) and All Babies in Southeast Sweden cohort (ABIS) from birth (1997-2009) and linked cohort data to national patient registers to identify IBD diagnoses through the end of 2024 and 2023, respectively. We included 111,293 participants with data on adverse life events reported during pregnancy, by age 1, or by age 3. Adverse life events included adverse maternal or familial events, such as divorce or loss of a family member, based on questionnaire data from the two prospective birth cohorts. Cox regression was used to estimate adjusted hazard ratios (aHRs) for IBD in children exposed versus unexposed to adverse maternal or family events, accounting for parental and child characteristics. Cohort-specific estimates were pooled using a random effects model. RESULTS:We identified 697 IBD events over 2,255,642 person-years of follow-up. Experience of maternal adverse events in pregnancy, reported by 22% of the mothers, was not associated with offspring IBD; pooled aHR 1.00 (95% confidence interval [CI] = 0.57-1.76), compared with no experience. Neither experience of adverse family events by age 1 year (pooled aHR 0.96, 95% CI = 0.80-1.15), nor by age 3 years (pooled aHR 0.99, 95% CI = 0.83-1.17) was associated with later IBD. CONCLUSIONS:This bi-national prospective cohort study found no support for the hypothesis that experiences of early-life adverse events increase the risk of IBD.
OBJECTIVES:Hypertransaminasemia is a frequent finding in hospitalized children with common pediatric illnesses, often considered a transitory phenomenon associated with systemic inflammation/injury. This study aims to assess the prevalence and causes of incidentally detected hypertransaminasemia in children admitted to general pediatric units for non-chronic liver-related illnesses. METHODS:This is a prospective, multicenter observational study. Children with transaminase measurement at hospital admission were enrolled from June 2021 to July 2023. Inclusion criteria were: Age >30 days to 17 years; hospitalization for any clinical condition; Informed consent. Patients with a previous diagnosis of liver disease were excluded. RESULTS:A total of 1652 patients (1 month to 17 years) were enrolled in nine Italian pediatric hospital centers. Overall, the prevalence of hypertransaminasemia was 34.4% (n = 570). The majority had mild to moderate liver enzymes elevation. Positive correlation were found between aspartate aminotransferase and creatin P-kinase (CPK), body mass index z-score and cholesterol. At discharge, 298 of the 570 re-tested transaminases: 21.4% (64/298) had persistent combined elevation, 13.8% (41/298) isolated alanine aminotransferase, and 37.6% (112/298) isolated elevation. Only 5.70% of the patients (n = 30) with elevated transaminase levels (n = 526) were eventually diagnosed with liver disease at discharge, whereas the majority of patients (19.9%, n = 105) received a diagnosis of pneumonia/bronchitis/upper respiratory tract infection, followed by unspecified infections (10.6%, n = 56). CONCLUSIONS:Hypertransaminasemia is common in children admitted to the general pediatric units, affecting approximately 35% of patients. Liver-related discharge diagnoses were uncommon among children with elevated transaminases (5.70%), whereas most cases occurred in the setting of acute non-hepatic illnesses. Children with persistently elevated transaminases at discharge should be followed to rule out chronic liver disease.
OBJECTIVES:Oesophageal stenosis is a serious sequel of caustic ingestion, especially refractory caustic oesophageal strictures (COS) with a high risk of adverse events and variable response to treatments such as dilations, infiltration of substances and stent placement. Platelet-rich plasma (PRP) has been used in various pathologies that require a process of repair and healing of tissues at the skin, mucosa and joints. We aimed to describe the experience managing refractory COS in children with endoscopic-guided PRP intralesional administration, in terms of practicability of the procedure, efficacy and safety in the first prospective series in Venezuela. METHODS:Children with refractory COS, with a length of evolution between 7 months to 3 years, and previous treatment attempts (steroids, Mitomycin C or stent placement), underwent endoscopic-guided PRP intralesional administration. RESULTS:Sixteen patients were included. After only one PRP administration session, 15/16 (93.8%) patients had improvement in dysphagia, in solid food tolerance and an increase in body weight. Only 4/16 (p < 0.001) requested a second infiltration session. One patient was withdrawn from the follow-up by the tutor. During the first 6-month follow-up, 15/15 patients, (p < 0.001) presented without dysphagia. There was no adverse event related to the dilation or PRP administration. CONCLUSIONS:The excellent response after endoscopic-guided PRP intralesional administration represents an effective and safe alternative for refractory COS children.
