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Balloon dilation of esophageal strictures in children
N Allmendinger1, M J Hallisey, S K Markowitz
1Division of Vascular/Interventional Radiology, Hartford Hospital, CT 06106, USA.
Insights
Fluoroscopically guided balloon catheter dilation offers a safe and effective treatment for pediatric esophageal strictures, achieving complete resolution in most cases. This minimally invasive approach is recommended over traditional dilation methods.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
Background:
- Esophageal strictures in children stem from various causes, including congenital anomalies, caustic ingestion, and post-surgical complications.
- Traditional management involves endoscopic dilation with bougie dilators under general anesthesia, which has limitations.
- Fluoroscopically guided balloon catheter dilation has emerged as a promising alternative.
Purpose of the Study:
- To evaluate the safety and efficacy of fluoroscopically guided balloon catheter dilation for treating focal esophageal strictures in children.
- To compare this technique with traditional dilation methods.
Main Methods:
- Eight pediatric patients (2 months to 14 years) with focal esophageal strictures underwent balloon catheter dilation.
- Procedures were guided by fluoroscopy.
- Treatment success was defined by complete resolution of strictures.
Main Results:
- Complete resolution of esophageal strictures was achieved in 6 out of 8 patients.
- An average of 7.5 dilation sessions were required (range, 1-14).
- No morbidity or mortality was reported during the study period.
Conclusions:
- Fluoroscopically guided balloon catheter dilation is a safe and effective treatment for benign esophageal strictures in children.
- It represents a preferred initial management strategy compared to traditional dilation techniques.
- This minimally invasive approach offers a favorable safety profile for pediatric patients.
Abstract:
Esophageal strictures in children may develop as a primary constriction, secondary to a surgically repaired esophageal atresia (with or without tracheoesophageal fistula), as a result of chemical injury after caustic ingestion, or following esophageal surgery. Traditional treatment of esophageal strictures has been limited to dilation (using bougie dilators) with esophagoscopy under general anesthesia. Recent reports have shown success with fluoroscopically guided balloon catheter dilation. Eight children (aged 2 months to 14 years) were treated with balloon catheter dilation for focal strictures of the esophagus. In six of the eight cases, complete resolution of the strictures was achieved after an average of 7.5 dilations (range, 1 to 14). Two of the eight patients moved to another part of the country and did not complete treatment. There has been no morbidity or mortality. In selected centers, balloon catheter dilation under fluoroscopic guidance has become a safe treatment of benign esophageal strictures in children. It should be considered the treatment of choice in the initial management of esophageal narrowing and appears to be safer than the more traditional methods of esophageal dilation.