Endoscopic therapy of oesophageal strictures in children – a multicentre study

Abstract

IntroductionOesophageal strictures are rare in children but may require endoscopic dilation.AimTo gather information on centres performing endoscopic oesophageal dilation in Poland.Material and methodsThe data were obtained from questionnaires concerning the relevant data mailed to 22 paediatric endoscopy centres. Completed questionnaires were received from 11 centres.ResultsIn 2010 the 11 Polish paediatric endoscopy centres performed a total of 10,650 endoscopic procedures. This included 347 oesophageal dilations in 106 paediatric patients aged from 1 month to 18 years. The numbers of patients treated at individual centres ranged from 2 to 40. The indications for oesophageal dilation were as follows: postoperative strictures in 68 children, oesophageal burns in 17 children, postinflammatory strictures in 14 children, achalasia in 4 children, and strictures caused by a foreign body in 3 children. Rigid guidewire dilators were used in the majority of procedures (271), rigid dilators without a guidewire in 32 procedures, and balloon dilators in 45 procedures. A total of 203 procedures were conducted under fluoroscopic guidance, and 144 without the use of fluoroscopy. The number of dilating sessions performed in individual children varied from 1 to 6 and more.ConclusionsOesophageal dilation constituted a minor proportion of all paediatric endoscopic procedures. The majority of children requiring dilation were patients up to 3 years of age with postoperative oesophageal strictures. In the majority of the centres rigid guidewire dilators were used, and in one third of the procedures these dilators were introduced without fluoroscopic guidance.

Efficacy and safety of endoscopic dilatation in the management of esophageal strictures in children

“…Previous studies reported successful outcomes approaching 80% in patients with GERD-related strictures. 7 , 11 , 13 In the present study, complete response was achieved in 70% of the cases and satisfactory response in 30%. Eighteen percent of our patients developed strictures secondary to EoE; complete response was achieved in 87.5% of the cases and satisfactory response was achieved in 12.5% cases.…”

“…6 In a recent multi-center survey that included 106 Polish children with esophageal strictures, post-TEF repair strictures were the most common indication for esophageal dilatation (64%), followed by caustic injury strictures in 16%, then post-inflammatory strictures in 13%. 7 …”

“…The median age of presentation in the present study was 2 years, which is consistent with the previous literatures (median, 2-3 years). 7 , 8 However, the present study did not aim to determine the prevalence of esophageal strictures but rather to study the efficacy and safety of endoscopic dilatation in the management of these cases. Endoscopic dilatation is increasingly being recognized as the treatment of choice in managing patients with esophageal strictures.…”

“…Several studies have shown the superior effectiveness and safety of EBD compared to semi-rigid dilators, with an efficacy that ranges between 76% and 100%, depending on the cause and criteria used to define effectiveness. 3 , 4 , 7 , 8 …”

Efficacy and safety of endoscopic balloon dilatation of esophageal strictures without fluoroscopy: a pilot study

“…The most common causes of esophageal stricture in adults are gastroesophageal reflux disease and esophageal cancer. Eighty percent of benign esophageal strictures occur after mucosal injury secondary to chronic acid exposure [1,2]. Pneumatic balloon dilatation is a technique that is used in esophageal strictures, has low complication rates compared to surgical procedures and can be performed more easily and safely [3].…”