Esophageal Dilation in Children

Abstract

Esophageal dilations in children are performed by several pediatric and adult professionals. We aim to summarize improvements in safety and new technology used for the treatment of complex and refractory strictures, including triamcinolone injection, endoscopic electro-incisional therapy, topical mitomycin-C application, stent placement, functional lumen imaging probe assisted dilation, and endoscopic vacuum-assisted closure in the pediatric population.

Recent Advances in the Genetic Pathogenesis, Diagnosis, and Management of Esophageal Atresia and Tracheoesophageal Fistula: A Review

“…Regardless of which dilator is selected, expert opinion in the ESPGHAN-NASPGHAN EA/TEF guidelines recommends insertion over a guidewire placed under endoscopic or fluoroscopic visualization, rather than blind dilation, to minimize the risk of esophageal perforation (23). EsoFLIP integrates the impedance planimetry technology of EndoFLIP into a balloon dilation catheter, allowing for real-time assessment of luminal diameter before, during, and after dilation and limiting the need for fluoroscopic radiation exposure (41).…”

“…Recurrent stricture is defined by an inability to maintain this diameter for 4 weeks after the initial achievement. Refractory stricture is characterized by failure to achieve an age-appropriate esophageal lumen, with 5 dilations over 5 months or with ≥7 dilations over any timeframe (41).…”

“…Late ES may also be associated with GERD or EoE (39). Clinical presentation of ES varies by age and may be subtle (41).…”

“…EndoFLIP measures the real-time luminal diameter, compliance, cross-sectional area, pressure, and distensibility index, making it a promising tool to guide and assess response to dilation. It is currently FDA-approved for children ≥5 years of age, although it has been performed safely in patients as young as 10 months (41). Initial management of simple or complex strictures can be accomplished with standard push (bougie) or balloon dilation.…”

Approach to Endoscopic Balloon Dilatation in Pediatric Stricturing Crohn Disease: A Position Paper of the Endoscopy Special Interest Group of ESPGHAN

“…It is reasonable to assess clinical improvement over the initial weeks to help guide timing of redilatation. Conversely, consideration should be given to the greater likelihood of reaching the dilatation target with earlier redilatation, which based on data relating to esophageal stricture dilatation (52), is probably between 2 and 4 weeks.…”