Comparative Analysis of Adverse Events After Esophageal Balloon and Bougie Dilations in Children

Abstract

Background: Pneumatic balloon and bougie dilation are widely used methods for pediatric esophageal dilation. There are no studies directly comparing the safety of these techniques in pediatric patients. This study compared adverse events (AEs) of balloon and bougie dilation in children at a single institution. Methods: AEs were identified by means of a prospective clinical registry of all procedure related AEs from 2012 to 2015 at a single institution. Identified AEs underwent retrospective review of procedural and clinical details. The category of each AE was recorded and severity was assigned using a 5-point scoring system. AEs were compared between balloon and bougie dilation for different severities. Results: There were 105 patients who underwent 246 dilation sessions. Balloon dilation was performed more commonly (n = 190, 77%) as compared to Maloney dilators (n = 56, 23%). Patients with balloon dilation were younger (3.0 vs 14.5 years, P = 0.0001) and more likely to have strictures from caustic ingestion (42% vs 2%, P < 0.0001) or surgical anastomoses (34% vs 5% P < 0.0001). Bougie dilation was used more commonly in patients with eosinophilic esophagitis (77% vs 7%, P < 0.0001)). In multivariate analysis, each year of increasing age was associated with a 12% increase in any AEs (P = 0.015), but no difference in clinically significant AEs (grade 2 or higher) was identified between dilation methods. Conclusions: Bougie and balloon dilation did not have significant differences in AE rates, but the patient populations differed between the 2 methods. The dilation method should depend on stricture characteristics and endoscopist expertise with each method.

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

“…209 Dilatation is equally effective and safe in adults and in children, with no differences in outcome between bougie or through the scope balloon dilators. [208][209][210] New techniques such as bougie caps have also been used and found to be a technically feasible and safe option. 211 Clinical outcomes of patients with stricture are better if therapeutic dilatation is combined with effective antiinflammatory therapy such as topical steroids GRADE of evidence: Moderate.…”

“…Following the publication of international guidelines59 and with improved understanding of the approach to stricture dilatation,203 the frequency of reported perforation is now very low at 0.38% in a meta-analysis of 1820 adult and paediatric EoE dilatations,208 and no more that is seen in other benign conditions of the oesophagus such as peptic stricture, and lower than is seen in achalasia and malignancy 209. Dilatation is equally effective and safe in adults and in children, with no differences in outcome between bougie or through the scope balloon dilators 208–210. New techniques such as bougie caps have also been used and found to be a technically feasible and safe option 211…”

Endoscopic approach to eosinophilic esophagitis: American Society for Gastrointestinal Endoscopy Consensus Conference

“…4,6 The type of dilator used (bougie or balloon) does not appear to influence risk. 118 Several systematic reviews have explored the safety of endoscopic dilation in EoE patients, and all have demonstrated that the rate of serious adverse events is very low. 95-97.119 In 1 limited meta-analysis, major adverse events occurred in <1% of EoE patients undergoing dilation.…”

Advancing patient care through the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR)

“…Adult gastroenterologists are typically more experienced with esophageal dilation and, in a number of research platforms, have helped to inform pediatric practitioners and others on the subtle differences in dilating the fibrotic organ. [54][55][56][57][58][59] In addition, because of the visualization and clinical effect of EoE on the barrier and fibrosis, gastroenterologists have embarked on basic studies to understand their basic mechanisms. [60][61][62][63] Finally, devices that have been developed to interrogate the esophagus in patients with other diseases or other parts of the gastrointestinal tract have now been brought to use in research studies focused on EoE.…”