Esophageal stricture dilatation in awake children

Dilatation of esophageal strictures in children has generally been performed in the hospital under general anesthesia, or under deep sedation. We report here a series of 211 dilatations in 13 pediatric patients who had these procedures performed in the outpatient department, 72% of them without any sedation, during a 4-year period. This report characterizes the children, the method of outpatient dilatation, and our results. At the end of the study period, six of the patients no longer required dilatation after five to 14 procedures; four patients still required dilatation at twice-yearly intervals; and three patients remained on an active schedule of dilatations at intervals less than 5 months. Esophageal lumen diameter increased and symptoms improved in all of the children. Catch-up weight gain occurred in one-half of those initially below the 10th percentile. Dilatation without anesthesia or sedation was preferred by all of the parents, and by those children old enough to express a preference. Estimated reduction of medical costs by more than $100,000 was realized, compared with bouginage using general anesthesia. No episode of perforation, significant hemorrhage, documentable aspiration, or neurologic complication occurred. Outpatient dilatation without anesthesia is an effective method of treating esophageal strictures in children.