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

Abstract

The study aims to evaluate the effectiveness and safety of endoscopic balloon dilatation (EBD) in childhood benign esophageal strictures. The medical records of 38 patients who underwent EBD from 1999 to 2013 were retrospectively reviewed. Demographic features, diagnoses, features of strictures, frequency and number of EBD, complications, outcome, and recurrence data were recorded. Median age was 1.5 years (0-14), and female/male ratio was 17/21 (n = 38). Primary diagnoses were corrosive esophageal stricture (n = 19) and esophageal atresia (n = 19). The length of strictures were less than 5 cm in 78.9% (n = 30). No complication was seen in 86.8% (n = 33). Perforation was seen in 10.5% (n = 4), and recurrent fistula was seen in 2.7% (n = 1). Total treatment lasted for 1 year (1-11). Dysphagia was relieved in 60.5% (n = 23). Recurrence was seen in 31.6% (n = 12). Treatment effectiveness was higher, and complication rates were lower in strictures shorter than 5 cm compared with longer ones (70% vs. 25%, P < 0.05, and 3.4% vs. 37.5%, P < 0.05). Although there was no statistical difference, treatment effectiveness rates were lower and complication and recurrence rates were higher in corrosive strictures compared with anastomotic ones (P > 0.05). EBD is a safe and efficient treatment choice in esophageal strictures, especially in strictures shorter than 5 cm and anastomotic strictures.

Pediatric Endoscopy, Update 2020

“…If a standard endoscope cannot be used, the balloon should be placed over a guide wire under X-ray guidance. The perforation rate for endoscopic balloon dilatation is given in the literature somewhere in between 0.1%-0.4% [1,2,39,40]. Gastrointestinal bleeding is rare in children.…”

“…It should only be mentioned that a removal is indicated within 4 h of the ingestion or when the foreign body is stuck in the esophagus [48]. Congenital diseases might present in a broad variety, however the most common indication for a gastroscopy due to congenital disease is the therapy of esophageal strictures [39,49,50].…”

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

“…In a 15-year retrospective study on 38 pediatric patients diagnosed with corrosive stricture (n Z 19) and esophageal atresia (n Z 19) who received EBD, Cakmak et al assumed that the treatment effectiveness rate was lower and the complication rate was higher in corrosive strictures than in anastomotic strictures; however, the difference was not statistically significant. 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.…”

Fluoroscopy During Esophageal Stricture Dilatation: Can It Be Considered Optional?

“…Corrosive ingestion-related esophageal strictures are most commonly treated initially by endoscopic dilatation which can be performed using bougie dilators such as Savary-Gilliard dilators or a balloon dilator passed through the working channel of endoscope. [7,8] Options for refractory or difficult to dilate esophageal strictures include topical corticosteroid (triamcinolone) injections, topical application or injection of mitomycin C, diathermy incision of strictures, placement of various types of retrievable esophageal stents (plastic, metal, or biodegradable), and surgical treatment. [9][10][11][12][13][14][15] Large published experiences are available with both bougie and balloon dilatation of esophageal strictures, be selective use of fluoroscopy, i.e., subjecting relatively easy-to-dilate patients to such procedures without fluoroscopy and selecting the difficult-to-dilate patients to traditional esophageal stricture dilatation procedure under fluoroscopy.…”

“…Long esophageal strictures, tortuous strictures, multiple strictures, strictures with pseudodiverticulum, and strictures with relatively thick esophageal wall can be relatively difficult to dilate and may require more number of dilatations. [1,2,8,17] However, ease of dilatation may not necessarily mean low risk of complications. Still another approach can be doing first session of esophageal dilatation under fluoroscopy and subsequent sessions of esophageal stricture dilatation without fluoroscopy, particularly when initial session was relatively easy to dilate with favorable stricture characteristics.…”