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Endoscopic balloon dilation of esophageal strictures in children
1Medical College of Virginia/Virginia Commonwealth University, Department of Pediatrics, Richmond.
Insights
Endoscopic balloon dilation effectively treats esophageal strictures in pediatric patients, with most achieving asymptomatic status. This minimally invasive approach offers a high success rate for various causes of esophageal narrowing.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Endoscopy
Background:
- Esophageal strictures are a significant complication following various surgical repairs and conditions in children.
- Management of pediatric esophageal strictures often requires repeated interventions.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic balloon catheter dilation for treating esophageal strictures in pediatric patients.
- To assess outcomes in children with esophageal strictures resulting from diverse etiologies.
Main Methods:
- A retrospective review of 17 pediatric patients (3 weeks to 14.5 years) with 20 esophageal strictures.
- Treatment involved 132 endoscopic balloon dilations over 42 months.
- Patients with reflux esophagitis also received medical management.
Main Results:
- Fifteen of 17 patients (88%) became asymptomatic after dilation.
- Average of 6.6 dilations per patient were required.
- Only one patient experienced a perforation; 16 procedures were performed in outpatients.
- Two patients remained symptomatic, one with epidermolysis bullosa and another post-Nissen fundoplication.
Conclusions:
- Endoscopic balloon dilation is a safe and effective treatment for pediatric esophageal strictures.
- The procedure allows for continued oral feeding and normal growth.
- Most patients achieve excellent long-term outcomes, with minimal complications.
Abstract:
A total of 17 patients, ages 3 weeks to 14 1/2 years, had 20 esophageal strictures develop after repair of esophageal atresia (9 strictures); primary gastroesophageal reflux (3 strictures); Nissen fundoplication (4 strictures); epidermolysis bullosa congenita dystrophica (1 stricture); congenital esophageal stenosis (2 strictures); or colonic interposition (1 stricture). These strictures were treated with 132 endoscopic balloon catheter dilations (average, 6.6/patient, range, 1 to 24) during a period of 42 months (average, 8 months; range, 2 to 42 months). Fifteen of the 17 patients are now asymptomatic. Thirteen of the 17 patients had documented reflux esophagitis and were also medically treated. The two residually symptomatic patients included a patient with severe proximal esophagitis secondary to epidermolysis bullosa congenita dystrophica who had only a temporary response to dilations and another patient with a tight Nissen fundoplication who did not improve after dilation but is now asymptomatic after corrective surgery. The 10 patients with tracheoesophageal fistula repair were asymptomatic within 3 to 21 months (average, 10.8 months). Only one patient had perforation develop as a result of the procedure. Sixteen of 17 patients had the procedures performed as outpatients. All patients were given oral feedings throughout the course of dilation and had normal growth.