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Esophageal Diameters in Children Correlated to Body Weight
Thomas Sebastian Bott1, Thekla von Kalle2, Alexander Schilling2
1Department of Pediatric Surgery, Olga Hospital, Klinikum Stuttgart, Stuttgart, Germany.
Insights
This study establishes a correlation between children's body weight and esophageal diameter, providing guidance for dilating esophageal stenoses. These findings offer a standardized approach for pediatric surgical interventions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Esophageal stenosis is a common complication following esophageal atresia repair and caustic burns in children.
- Current treatment involves repeated balloon dilatations, but standardized sizing guidelines are lacking.
- This variability in treatment can lead to suboptimal outcomes for pediatric patients.
Purpose of the Study:
- To establish a correlation between body weight and esophageal diameter in children.
- To provide data for standardizing balloon dilatation in treating pediatric esophageal stenosis.
- To improve treatment efficacy and patient outcomes.
Main Methods:
- Retrospective analysis of 60 upper gastrointestinal (GI) studies in children (2011-2016).
- Blinded, multi-examiner evaluation of esophageal diameters at standardized anatomical points (2nd-3rd and 7th-8th ribs).
- Correlation of measured esophageal diameters with patient body weight.
Main Results:
- A significant linear correlation was found between esophageal diameter and body weight (coefficients 0.67-0.70).
- Mean esophageal diameter ranged from 6.75 mm (2.6 kg) to 14 mm (74 kg).
- Data provided weight-specific measurements and confidence intervals for clinical application.
Conclusions:
- This study offers the first evidence-based guidance for dilating esophageal stenoses based on body weight in children.
- The findings provide a reliable reference for determining appropriate balloon sizes during dilatation procedures.
- Standardizing esophageal stenosis treatment can lead to improved clinical results in pediatric surgery.
Introduction:
The development of stenoses after correction of an esophageal atresia or acid and lye burn of the esophagus are well-known problems in pediatric surgery. Currently, stenoses are treated in the majority of cases by repeated balloon dilatations. The diameter of the balloons used is not standardized; standard curves do not exist. The aim of this study was to evaluate the diameter of the esophagus correlated to the body weight of the children as measured in upper gastrointestinal (GI) studies to answer the important question to what extent a stenosis should be dilated.
Materials And Methods:
Within the time period from 2011 through 2016, 60 patients with upper GI studies were selected. Evaluations were blinded to two different examiners. The diameters were measured under maximum contrast filling between the second and third rib (cranial point of measurement) and between the seventh and eighth rib (caudal point of measurement). For both, the anteroposterior and lateral aspect was examined. The diameter was calculated as the arithmetic average of both measurements within one level. The diameters were correlated to the weight of the children.
Results:
All children (n = 38) within the 3rd to 97th weight percentile were analyzed. Linear correlation and coefficients of 0.67 at the cranial point and 0.70 at the caudal point were found. Mean diameter at the cranial point of measurement was 6.75 mm at the lowest weight (2.6 kg) and 14 mm at 74 kg. Mean weight of these children (standard deviation [SD]) was 25.3 (18.8) kg and median age was 7 years. Within weight groups (0-10 kg; 10-20 kg; 20-35 kg; 35-50 kg; >50 kg), we calculated SD and two side tested critical 95% confidence interval for all measurements (n = 74).
Conclusion:
Although the variation in measurements is considerable, this evaluation gives a reliable hint to which extent esophageal stenoses should be dilated in relation to the body weight. To the best of our knowledge, this is the first investigation to evaluate the diameter of the esophagus in children in relation to the body weight.
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