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Published on: April 17, 2020
Endoscopic versus fluoroscopic esophageal dilatations in children with esophageal strictures: 10-year experience
Adi Marom1, Zev Davidovics2, Tali Bdolah-Abram3
1Hebrew University- Hadassah Medical School, Jerusalem, Israel.
Insights
Endoscopic and fluoroscopic balloon dilatations for pediatric esophageal strictures show similar success rates. However, endoscopic guidance resulted in significantly fewer complications, making it a potentially safer treatment option for children.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Interventional Radiology
Background:
- Esophageal strictures in children can lead to significant feeding difficulties and failure to thrive.
- Balloon dilatation is a common treatment for pediatric esophageal strictures.
- Comparative data on endoscopic versus fluoroscopic guidance for this procedure is lacking.
Purpose of the Study:
- To compare the efficacy and safety of endoscopic versus fluoroscopic guidance for balloon dilatations in treating pediatric esophageal strictures.
- To evaluate short-term (3-month) and long-term (12-month) success rates.
- To assess complication rates, including bleeding and perforation.
Main Methods:
- Retrospective review of medical records for children aged 0-18 years treated between 2010 and 2020.
- Analysis of 174 balloon dilatation sessions across 46 patients.
- Comparison of outcomes based on endoscopic versus fluoroscopic guidance.
Main Results:
- Success rates at 3 months (62% vs. 67%) and 12 months (57% vs. 67%) were comparable between endoscopic and fluoroscopic groups (p > 0.05).
- The complication rate was significantly lower in the endoscopic group (0%) compared to the fluoroscopic group (15%) (p < 0.001).
Conclusions:
- Both endoscopic and radiologic-guided balloon dilatations are equally effective for treating pediatric esophageal strictures.
- Endoscopic guidance offers a safer alternative due to a lower incidence of complications.
Abstract:
Esophageal strictures in children may cause dysphagia, choking during feeds, and failure to thrive. They can be treated by balloon dilatations, either under endoscopic or fluoroscopic guidance; there is no literature comparing the methods. Retrospective review of the medical records of children (0-18 years) who were treated with balloon dilatations between 2010 and 2020. The primary outcome was the number of dilatation sessions required until clinical success after 3 months. Secondary outcomes were long-term success at 12 months, and complications of bleeding and perforation. Forty-six patients underwent 174 dilatation sessions. Success rates in the endoscopy and fluoroscopy groups were similar: 62% versus 67% (p = 0.454) at 3 months and 57% versus 67% (p = 0.721) at 12 months. Complication rate was lower in the endoscopy group (0% vs. 15%, p < 0.001). Both endoscopic and radiologic-guided balloon dilatations were shown to be equally effective, but endoscopic guidance had fewer complications.
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