Clinical and nutritional outcome of pediatric esophageal stenosis with endoscopic balloon dilatation

Chang, Chun‐Hsiang; Chao, Hsun‐Chin; Kong, Man‐Shan; Chen, Shih-Yen; Chen, Chien‐Chang; Lai, Ming-Wei

doi:10.1016/j.pedneo.2018.04.013

Cited by 15 publications

(25 citation statements)

References 24 publications

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“…Retrospective reviews have reported up to 33 balloon procedures in a single patient, and a ten‐year retrospective review in the UK found that 148/166 patients (89%) required multiple balloon procedures . In our study, 56% of patients (33/59) had multiple balloon procedures to maintain the airway.…”

Section: Discussionmentioning

confidence: 47%

“…Overall procedural success and clinical outcomes for all balloon dilatation patients (n = 59) using follow-up from the Airway Intervention Registry and administrative data from Hospital Episodes Statistics Retrospective reviews have reported up to 33 balloon procedures in a single patient, 13 and a ten-year retrospective review in the UK found that 148/166 patients (89%) required multiple balloon procedures. 14 In our study, 56% of patients (33/59) had multiple balloon procedures to maintain the airway.…”

Section: F I G U R Ementioning

confidence: 99%

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Balloon dilatation for paediatric airway stenosis: Evidence from the UK Airway Intervention Registry

Powell

Keltie

Burn

et al. 2020

Clinical Otolaryngology

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Objectives:To assess the safety and efficacy in routine clinical practice of balloon dilatation procedures in the treatment of paediatric airway stenosis.Design: Observational data collection in prospective online research database.Setting: Acute NHS Trusts with ENT department undertaking complex paediatric airway work.Participants: Children (<18) undergoing balloon dilatation treatment for airway stenosis. Main outcome measures: Airway diameter, complications, hospital resource usage.Results: Fifty-nine patients had 133 balloon procedures during 128 visits to 10 hospitals. Sixty-nine (52%) of balloon procedures were conducted with a tracheostomy.Intra-operative Cotton-Myer grade decreased in 43 (57%). The mean pre-balloon subglottic diameter was 4.2 [95% CI: 3.8 to 4.5] mm, and its rate of increase was 0.8 [0.5 to 1.2] mm per year modelled on 30 patients' long-term data. As the primary treatment of stenosis, the procedural success rate of balloon dilatation (n = 52) was 65% (22% with tracheostomy, 88% without tracheostomy), and 71% as an adjunct to open reconstructive surgery (n = 7). In the 64 hospital visits where a balloon procedure was conducted with a tracheostomy in place, only one in-hospital complication (lower respiratory tract infection) occurred. For those without a tracheostomy in place, inhospital complications occurred in seven of 64 balloon hospital visits, all related to ongoing or worsening stenosis. Six out-of-hospital complications were deemed related to ongoing or worsening stenosis following the procedure, and two complications were a combination of lower respiratory infection and ongoing or worsening stenosis. Conclusions: Balloon dilation increases the size of the airway intraoperatively andis associated with long-term increase in airway diameter. Safety outcomes mostly relate to ongoing or worsening stenosis and are more common in patients without a tracheostomy.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Section: Discussionmentioning

confidence: 47%

Section: F I G U R Ementioning

confidence: 99%

Balloon dilatation for paediatric airway stenosis: Evidence from the UK Airway Intervention Registry

Powell

Keltie

Burn

et al. 2020

Clinical Otolaryngology

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“…Achieving sufficient food intake is the target of esophageal dilatation in patients with esophageal stricture [ 8 ]. If left untreated, patients with esophageal stricture may suffer from failure to thrive and can develop serious complications [ 3 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Endoscopic Esophageal Dilatation in Pediatric Patients with Esophageal Strictures

Isa

Ali

Ahmed

et al. 2021

International Journal of Pediatrics

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Background and Objectives. Benign strictures are the main cause of esophageal strictures in children. They can be managed by different modalities but endoscopic dilatation is the standard therapy. This study is aimed at reviewing the efficacy and safety of endoscopic dilatations in children with esophageal strictures. Materials and Methods. In this retrospective cross-sectional single center study, records of patients with esophageal strictures presented to the pediatric department, Salmaniya Medical Complex, Bahrain, in the period between 1995 and 2019 were reviewed. Demographic data, indications of endoscopic dilatations, the procedure success rate, and possible complications were assessed. Results. Forty-six children were found to have esophageal strictures. Twenty-five (54.3%) patients were males. Most patients presented during infancy (86.5%, 32/37 patients). Twenty-six (56.5%) patients required 88 dilatation sessions, while the remaining 20 (43.5%) patients did not require dilatations. The median number of dilatation sessions per patient was three (interquartile range = 2 –5). Savary-Gilliard bougienages were the main dilators used (80.8%, 21/26 patients). Anastomotic stricture (post esophageal atresia/tracheoesophageal fistula repair) was the main cause of esophageal strictures and was found in 35 (76.1%) patients. Patients with nonanastomotic strictures had more frequent dilatations compared to those with anastomotic strictures ( P = 0.007 ). The procedure success rate was 98.8%. Yet, it was operator dependent ( P = 0.047 ). Complete response to dilatation was found in 18 (69.2%) patients, satisfactory in seven (26.9%), and an inadequate response in one (3.9%). Those with satisfactory responses still require ongoing dilatations based on their symptoms and radiological and endoscopic findings. No perforation or mortality was reported. Patients with dilatations had more recurrent hospitalization ( P < 0.0001 ), more dysphagia ( P = 0.001 ), but shorter hospital stay ( P = 0.046 ) compared to those without dilatations. Surgical intervention was required in one patient with caustic strictures. The median follow-up period was six years (interquartile range = 2.25 –9.0). Conclusions. Endoscopic esophageal dilatation in children with esophageal strictures is effective and safe. Yet, it was operator dependent. Nonanastomotic strictures require more dilatations compared to anastomotic strictures. Findings of this study are comparable to those reported worldwide.

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“…Chang et al reported a 5year retrospective study on 50 pediatric patients showing an overall clinical success rate of EBD therapy as high as 72% with emphasis of significantly increased weight-for-age z scores in all the patients receiving EBD, particularly in those with short strictures and strictures in the middle esophagus. 7 This report is the first to correlate long-term nutritional outcomes in weight-for-age z scores with the location and length of esophageal strictures, 7 rather than evaluating patients only with BMI as well as variations in the z scores of weight and height. 3,6 Whether different etiologies correlate with clinical outcomes and effectiveness of EBD for esophageal strictures in children remains obscure and requires additional studies for clarification.…”

mentioning

confidence: 99%

“…8 Chang et al claimed higher clinical success rates of EBD in patients with esophageal atresia than those with corrosive injury by statistical analysis from not all but a part of the enrolled patients. 7 Timing of EBD treatment and severity of corrosive injury should be considered in future studies. Moreover, we anticipated further research on advanced therapies (e.g., intralesional steroid injection or topical Mitomycin C) as rescue adjuncts to treat patients with recurrent or refractory esophageal strictures resistant to EBD therapy.…”

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confidence: 99%

Endoscopic balloon dilatation in pediatric patients with esophageal strictures: From the past to the future

Fang

2019

Pediatrics & Neonatology

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Clinical and nutritional outcome of pediatric esophageal stenosis with endoscopic balloon dilatation

Abstract: EBD has good long-term clinical success and nutritional promotion in pediatric patients with esophageal stricture, especially in short segment stricture or stricture in the middle esophagus.

Cited by 15 publications

References 24 publications

Balloon dilatation for paediatric airway stenosis: Evidence from the UK Airway Intervention Registry

Balloon dilatation for paediatric airway stenosis: Evidence from the UK Airway Intervention Registry

Efficacy and Safety of Endoscopic Esophageal Dilatation in Pediatric Patients with Esophageal Strictures

Endoscopic balloon dilatation in pediatric patients with esophageal strictures: From the past to the future

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