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[Esophageal dilatation in pediatrics: study of 33 patients]
F Huet1, J F Mougenot, T Saleh
1Service de gastroentérologie et nutrition pédiatrique, hôpital Robert-Debré, Paris, France.
Insights
Esophageal dilatation is a safe and effective treatment for childhood esophageal stenosis, with 76% of patients showing significant improvement. Strict safety protocols and experienced operators are crucial for successful outcomes in pediatric cases.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Pediatric Surgery
Context:
- Esophageal stenosis in children presents a significant clinical challenge.
- Esophageal dilatation is a common therapeutic approach, but pediatric data on its efficacy and safety are limited.
- Understanding indications and complications is vital for optimizing treatment strategies.
Purpose:
- To evaluate the efficacy and safety of esophageal dilatation in pediatric patients with esophageal stenosis.
- To analyze the outcomes based on the underlying causes of stenosis.
- To identify potential complications associated with the procedure.
Summary:
- A retrospective review of 33 children treated with esophageal dilatation for stenosis (1983-1992) was conducted.
- The study analyzed outcomes across four etiological groups: esophageal atresia repair, caustic esophagitis, peptic esophagitis, and unclassified stenosis.
- Overall, 76% of patients improved, while 3.4% experienced complications, including perforation and cardiac events; outcomes varied by etiology.
Impact:
- Esophageal dilatation is a simple and effective treatment for pediatric esophageal stenosis when performed by experienced operators adhering to safety guidelines.
- The findings provide valuable insights into the indications, efficacy, and complication rates in specific pediatric populations.
- This study supports the continued use of esophageal dilatation as a primary intervention in managing childhood esophageal strictures.
Background:
Esophageal dilatation is usually regarded as an effective therapy in a majority of esophageal stenosis in childhood. However, the limited number of pediatric data does not allow definite conclusions on indications and complications of such a procedure.
Patients And Methods:
The files of 33 children whose esophageal stenosis had been treated by dilatation by the same operator between 1983 and 1992 were retrospectively reviewed. The structure mechanisms were: group 1: repair of esophageal atresia (n = 9), group 2: caustic esophagitis (n = 6), group 3: peptic esophagitis (n = 12), group 4: unclassified structures (congenital esophageal stenosis, achalasia) (n = 6). The dilatations were performed under general anesthesia, and the dilatator guide was introduced under endoscopic control. Two methods were used: Savary esophageal bougies and balloon dilatation. A thoracic X-ray was systematically performed after each dilatation.
Results:
One hundred and fourteen dilatations (3.5 dilatations/child) were performed (range: 1-32 dilatations). Twenty-five of the 33 children (76%) were dramatically improved after mechanical dilatation. Esophageal dilatation was unsuccessful in the eight other patients, seven of them requiring a surgical repair. Complications occurred in 3.4% of the dilatations: one esophageal perforation, one pneumomediastinum and two cardiac arrests (one of vagal origin and 1 after accidental extubation). All patients survived. Efficacy, duration of dilatation and complication rates were not similar in the four groups.
Conclusions:
Esophageal dilatation should be considered as a simple and effective procedure when strict security rules are respected by a trained operator.