Efficacy and safety of endoscopic dilatation in the management of esophageal strictures in children

Abstract

Objectives:To determine the outcomes of endoscopic dilatation of esophageal strictures in children.Methods:Children younger than 18 years of age diagnosed with esophageal strictures over a period of 7 years (June 2010 to June 2017) were reviewed and analyzed retrospectively. The study took place at King Khalid University Hospital, Riyadh, Saudi Arabia. The patients’ clinical characteristics, endoscopic findings, and details of the strictures, treatment, and outcomes were documented.Results:Forty-three children with esophageal strictures were identified (median age, 8.1 years; range, 2-17 years; 23 [53.5%] boys). The median age at presentation was 2 years (range, 1-16 years), and the median follow-up period was 3 years (range, one month-17 years). Tracheoesophageal fistula (n=14, 32.6%), gastroesophageal reflux disease (n=10, 23.3%) and eosinophilic esophagitis (n=8, 18.6%) were the leading causes of esophageal strictures. Forty-three patients underwent 180 dilatation sessions; the median number of dilatation sessions per patient was 3 (range, 1-48), and the median interval between sessions was 8 weeks (range, 1-24 weeks). Among 180 dilatation sessions, 3 events (1.7%) of esophageal perforation were observed. The outcomes varied depending on the primary cause of the stricture; complete response was achieved the best in eosinophilic esophagitis-related strictures (87.5%), followed by anastomotic strictures post tracheoesophageal fistula repair (71.4%) and gastroesophageal reflux disease-related strictures (70%).Conclusion:Endoscopic dilatation is a safe and effective intervention in the management of esophageal strictures in children, with minimal complications when conducted by experts.

Complications of esophageal strictures dilatation in children

“…Previous studies have reported successful results of almost 80% in patients with GERD-related stenosis. 8 In the present study, a complete response was achieved in 67% of the cases and a satisfactory response in 30%.…”

“…Surgery is usually reserved for resistant types of esophageal strictures, such as long strictures and cases of congenital stenosis. 8 Multiple studies have analyzed esophageal dilatation and have obtained variable results. 9 , 10 Thus, the present study aimed to report the outcomes of endoscopic dilatation of esophageal strictures in children, its complications, and management.…”

Efficacy and Safety of Endoscopic Esophageal Dilatation in Pediatric Patients with Esophageal Strictures

“…Benign esophageal stricture is the main cause of esophageal stricture in children. Management of these strictures includes medical therapy, esophageal dilatation, and surgical intervention [ 1 ].…”

“…These are performed to interfere with the remodeling of the scar before it became stiff [ 7 ]. Currently, three types of esophageal dilators are in practice: wire-guided Savary-Gilliard bougienages (SGB), weighted Maloney dilators, and endoscopic balloon dilators (EBDs) [ 1 , 6 , 7 , 9 ]. Endoscopic dilatations using SGB is the traditional therapy of esophageal strictures in children [ 10 ].…”

“…Endoscopic dilatations using SGB is the traditional therapy of esophageal strictures in children [ 10 ]. Yet, EBDs are increasingly recognized as a better option [ 1 ].…”