Balloon Dilatation for Corrosive Esophageal Strictures in Children: Radiologic and Clinical Outcomes

Abstract

ObjectiveWe retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture.Materials and MethodsThe study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5).ResultsA total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD.ConclusionOnly a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management.

Topical mitomycin C can effectively alleviate dysphagia in children with long-segment caustic esophageal strictures

“…This long period of treatment has its psychological, social, and economic drawbacks on the child, the parents, and the society. Besides this drawbacks, the recurrence rate is very high, and most of these children refereed eventually to surgical replacement of the native esophagus . In our center, long tortuous caustic esophageal stricture was considered in the last decade as a contraindication for endoscopic dilatation, and these patients were referred for colon interposition from the start …”

Endoscopic balloon dilatation of benign esophageal strictures in childhood: a 15-year experience

“…The evolution of esophageal stricture treatment from open surgery to dilatation with bougies, and then to balloon catheters, was therefore inevitable. Besides the traditional methods, surgical revision and bougienage, currently esophageal dilatation with balloon catheter is increasingly used as a treatment modality in esophageal strictures . Balloon dilatation has also been used for childhood strictures, especially after the report of London et al .…”

Endoscopic cicatrectomy for corrosive esophageal strictures just below the piriform fossa

“…Overall success rates of balloon dilatation including stenosis after esophageal anastomosis have been reported within the range of 67e90%, although the success rate in patients with corrosive esophageal stricture is low (29e70%). Furthermore, the rupture rate of balloon dilatation for corrosive esophagitis is higher than for postoperative strictures, since corrosive esophagitis increases tissue resistance and reduces tissue elasticity due to progressive fibrosis and dense scarring [2]. The patient in the present case underwent balloon dilation 13 times in 22 weeks, but no amelioration of constriction was obtained.…”

“…Esophageal stricture may develop in 7e15% of patients with corrosive burns, forming within 3e4 weeks after injury [2,4]. Esophageal dilatation, such as esophageal bougienage or balloon dilatation as applied in the current case, has been the primary treatment for focal esophageal stricture.…”

“…However, many patients with corrosive esophageal strictures develop recurrence of symptoms after dilatation. Surgical intervention has been used in cases requiring repeated dilatation or showing failure of dilatation therapy [1,2]. Esophagectomy or esophageal replacement is often required as surgical intervention [3], but both are invasive, especially in children.…”