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Complications of esophageal strictures dilatation in children. A tertiary-center experience
Osama Bawazir1, Mohammed O Almaimani
1Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia. E-mail. obawazir@yahoo.com.
Insights
Endoscopic esophageal dilatation effectively treats pediatric strictures, with balloon dilation being the primary method. While repeated procedures are common, especially for corrosive cases, complications are infrequent, and surgery is rarely needed.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Esophageal Diseases
Background:
- Esophageal strictures in children present a significant clinical challenge.
- Outcomes of esophageal dilatation can vary based on the underlying cause of the stricture.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic dilatation for pediatric esophageal strictures.
- To analyze complications and management strategies associated with the procedure.
- To investigate the influence of etiology on treatment outcomes.
Main Methods:
- Retrospective analysis of 46 pediatric patients undergoing esophageal dilatation between 2014-2019.
- Pre-dilation contrast studies assessed stricture characteristics.
- Data collected included dilator type, number of sessions, intervals, and follow-up duration.
Main Results:
- Endoscopic balloon dilatation was the predominant treatment (63%).
- Significant increase in esophageal diameter post-dilation (9 mm to 12 mm, p < 0.001).
- Median of 3 dilatation sessions required; median follow-up 2.18 years.
- Esophageal perforation occurred in 4.3% of cases.
Conclusions:
- Endoscopic dilatation is an effective treatment for pediatric esophageal strictures.
- Repeated dilatations are often necessary, particularly for corrosive strictures.
- Complications are uncommon, and surgical intervention is infrequently required.
Objectives:
To report the results of endoscopic dilatation of esophageal strictures in children, its complications, and their management. The outcomes of esophageal dilatation differ according to the underlying etiology.
Methods:
The study included 46 patients who underwent esophageal dilatation between 2014-2019. All patients underwent a contrast study of the esophagus before endoscopic dilation to determine the location, number, and length of the narrowing. In addition, the type of dilators (balloon versus semi-rigid dilators), the number of dilatation sessions, the interval between them, and the duration of follow-up were also documented. The median age was 2.47 years, and 26 patients were females. Dysphagia was the main presenting symptom, and the leading cause of stricture was esophageal atresia.
Results:
The main treatment modality was endoscopic balloon dilatation (n=29, 63%). The esophageal diameter was significantly increased after dilation (9 [7-11] versus 12 [10-12.8]) mm; p less than 0.001). Topical mitomycin-C was used as adjuvant therapy in 3 patients (6.5%). Esophageal perforation was reported in 2 cases (4.3%). Patients needed a median of 3 dilatation sessions, 25-75th percentiles: 1-5, and the median duration between the first and last dilatation was 2.18 years 25-75th percentiles: 0.5-4.21.
Conclusion:
Esophageal dilatation is effective for the management of children with esophageal stricture; however, repeated dilatation is frequent, especially in patients with corrosive strictures. Complications are not common, and open surgery is not frequently required.
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