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[Endoscopic balloon dilatation of esophageal strictures in children]
C Cabrera Chamorro1, C Méndez Manchola2, I Molina Ramírez2
1Unidad de Cirugía Pediátrica, Fundación Hospital de la Misericordia, Universidad Nacional de Colombia, Bogotá DC, Colombia. cccabrerach@gmail.com
Insights
Endoscopic balloon dilatation is a safe and effective first-line treatment for pediatric esophageal stenosis. This study shows a high success rate in improving swallowing difficulties in children, with minimal complications.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Esophageal Disorders
Context:
- Esophageal stenosis in children can result from various causes, including esophageal atresia repair, caustic injuries, and gastroesophageal reflux.
- Management often requires interventions to restore adequate esophageal diameter and function.
- Endoscopic balloon dilatation is a minimally invasive therapeutic option.
Purpose:
- To assess the safety and efficacy of endoscopic balloon dilatation for treating esophageal stenosis in pediatric patients.
- To evaluate treatment outcomes based on response and effectiveness criteria.
- To identify complications associated with the procedure.
Summary:
- A retrospective study analyzed 576 endoscopic balloon dilatation procedures in 89 children (1-202 months) with esophageal stenosis.
- The treatment was effective in 79.7% of cases, with excellent or satisfactory responses in over 48% of patients.
- Esophageal perforations occurred in 1.38% of procedures; concomitant gastroesophageal reflux disease was noted in 38.2% of patients.
Impact:
- Endoscopic balloon dilatation demonstrates significant effectiveness and a favorable safety profile as a primary treatment modality for pediatric esophageal stenosis.
- The findings support its use as a first-line therapy, potentially reducing the need for more invasive surgical interventions.
- Further research may focus on optimizing management strategies for refractory cases, particularly those with associated gastroesophageal reflux disease.
Objectives:
To evaluate the effectiveness and safety of endoscopic balloon dilatation in children with esophageal stenosis.
Patients And Methods:
Retrospective study of patients treated in the last 5 years, diagnosed with esophageal stricture. Response to dilatation was defined as excellent when there was no need for any additional dilatation for recurrent dysphagia, satisfactory when they set out to 5 sessions, acceptable with more than 5 sessions, and inadequate if there was no improvement of dysphagia with dilation. The treatment was effective when dysphagia remained grade 0 or 1 was kept for more than 12 months after the last dilatation session.
Results:
576 procedures were performed in 89 children, with an average of 6,47 per patient (range 1-33). The esophageal stenosis was secondary to esophageal atresia repair in 51 cases (57,3%), injury by caustic in 19 patients (21,3%) and gastroesophageal reflux 11 cases (12,3%); compromised aged between 1-202 months (mean 36,1). Response to dilatation was excellent in 11 patients (13.9%), satisfactory in 27 (34.1%), fair in 25 (31.6%), and inadequate in 16(20.2%). Ten patients (8.9%) were lost to follow up. Thirty-four (38.2%) patients were diagnosed with concomitant gastroesophageal reflux disease, every one recieved medical management and 7 (20,5%) underwent antireflux surgery. The treatment was effective in 63 cases (79.7%) and ineffective in 16 (20.2%), most of the latter with gastroesophageal reflux. There were 8 complications (1,38%), all esophageal perforations.
Conclusions:
Endoscopic balloon dilatation can be accomplished safely and effectively as a first-line therapy for the management of esophageal stenosis.
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