To evaluate the sustained efficacy of oral viscous budesonide (OVB) maintenance therapy compared to treatment discontinuation in children with repaired esophageal atresia (EA) and steroid-responsive recurrent anastomotic stricture (AS), hypothesizing that OVB will significantly improve dilation-free survival.
Key Findings:
Dilation-free survival was significantly higher in the OVB group (91%) compared to controls (50%, p = 0.037).
Dilation recurrence occurred in 25% of OVB patients versus 70% of controls (p = 0.043).
Median time to recurrence was longer in the OVB group (13 months) compared to controls (7 months).
Dysphagia scores were significantly lower in the OVB group.
No systemic adverse effects were observed.
OVB was independently associated with lower dilation risk (adjusted HR 5.68; 95% CI 1.08–27.4).
Interpretation:
Maintenance therapy with OVB significantly prolongs dilation-free intervals in children with recurrent AS after EA repair, suggesting its potential as a disease-modifying therapy.
Limitations:
Small sample size (22 patients) may limit the statistical power and generalizability of the findings.
Short follow-up duration (6 months) restricts the ability to assess long-term outcomes.
Single-center study may limit generalizability.
Conclusion:
OVB maintenance therapy is effective in reducing recurrence of dilation in children post-EA surgery, supporting its use as a potential long-term treatment strategy, but further studies are needed to confirm its long-term efficacy.
