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Published on: December 14, 2020
Predictors of clinical response of esophageal dilatations in pediatric population
Silvia Aragón1, Juan Valero1, Laura Padilla2
1Pediatric Surgery, Universidad Nacional de Colombia, Hospital La Misericordia, Bogotá 110121, Colombia.
Insights
Pediatric esophageal stricture dilatations show variable effectiveness. Factors like airway compromise predict poor outcomes, while shorter strictures and initial endoscope passage improve prognosis for children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Otolaryngology
Background:
- Esophageal strictures are common in children, frequently managed by pediatric surgeons.
- Limited studies identify prognostic factors for pediatric esophageal stricture treatment outcomes.
Purpose of the Study:
- To identify prognostic factors influencing the effectiveness and complications of esophageal dilatations in pediatric patients.
- To evaluate outcomes of esophageal dilatation for pediatric strictures.
Main Methods:
- Retrospective review of medical records for pediatric patients undergoing esophageal dilatation for strictures (January 2015 - December 2018).
- Statistical analysis to determine prognostic factors for dilatation effectiveness and complications.
- Level III evidence study.
Main Results:
- 663 procedures in 111 patients; common causes include esophageal atresia (56%), corrosive strictures (24%), and idiopathic (11%).
- Global effectiveness (dysphagia score, discharge, no surgery) was 49%. Complication rate was 1.9% (esophageal perforation most frequent).
- Predictors of ineffective dilation: airway compromise, feeding surgery history. Better prognosis: shorter strictures (<2cm), mid-esophageal location, successful first-pass endoscope passage. Airway involvement linked to complications.
Conclusions:
- Esophageal dilatations are crucial for managing pediatric strictures.
- Identified prognostic factors impact dilatation effectiveness and complication rates.
- Further research is needed to establish a gold standard for effectiveness in pediatric esophageal strictures.
Introduction:
Esophageal strictures are a common condition, and pediatric surgeons confront them regularly. Despite being performed very frequently, there ared not studies that clearly identify prognostic factors for pediatric patients.
Methods:
Medical records of the children who were taken to esophageal dilatation due to strictures from January 2015 to December 2018 were reviewed. Statistical analysis was performed to establish prognostic factors.
Results:
Six hundred sixty-three procedures were performed in 111 patients. The majority of patients had antecedent of esophageal atresia 56%, corrosive stricture in 24%, idiopathic 11%, and Gastroesophageal Reflux (GER) in 9%. The effectiveness of the dilatations was evaluated against three parameters: Dysphagia 0 or 1 in the last assessment 82%. Discharge from dilatation protocol 64%, and no need for surgery 74%. The Global effectiveness was determined by fulfilling the three previous outcomes and was of 49%. The complication rate was 1.9%, being esophageal perforation the most frequent. The statistically significant predictors for the ineffective dilations were airway compromise and history of feeding surgery. The length fewer than 2 cm of the stricture, the location in the middle third of the esophagus and the endoscope passage in the first procedure were factors associated with a better prognosis. Airway involvement was also a variable associated with more significant complications.
Conclusions:
Esophageal dilatations are a fundamental part of the management of strictures. This study found relevant prognostic factors for both the effectiveness of the dilatations and the complications of these. More studies are needed for a gold standard of effectiveness in this condition.
Level Of Evidence:
This is a retrospective study of level III of evidence.
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