RESULTS OF ENDOSCOPIC DILATION IN TREATMENT OF ESOPHAGEAL STRICTURES AT CHILDREN HOSPITAL 1

Abstract

Objective: Esophageal strictures (ES) in children is usually due to benign causes, most commonly due to anastomotic stricture (AS) and caustic injury (CI). Endoscopic dilation (ED) in treatment of has been carried out since 2009 at Children's Hospital 1 with bougie dilators, and from October 2018, with the addition of a multi-diameter hydrostatic balloon - with guidewire. We evaluate the results and complications of this method in the treatment of esophageal strictures in children at Children's Hospital 1.

Methods: We analyzed retrospectively all patients who had an endoscopy esophageal dilatation at our center from May 2016 to May 2021.

Results: Thirty-five patients underwent ED (20 boys, 15 girls) included 24 AS, 10 CI, and 1 esophageal web; in which 13 cases had balloon dilations, 10 cases had bougie dilations and 10 cases had both types. Total number of dilations were 388; median dilations per AS and IS patient were 5.1 (1-18) and 19.6 (3 – 60) respectively (U, p <0.05). The number of cases requiring dilatation <5 times and ≥5 times was 42.9% and 57.1%, respectively. Median follow-up time was 18.7 (3-43) months. The overall success rate of ED is 82.9%, the success rate of AS and CI is 95.8% and 60%, respectively. The failure rate of ED is 17.1% (6/35 cases). The rate of esophageal perforation was 0,5% (2/388 dilations). One case (2.9%) had mild aspiration pneumonia after bougie dilation. There were no deaths in our study.

Conclusion: Endoscopic dilation of the esophagus in the treatment of esophageal stricture in children is safe and effective, the rate of failure and complications is low.

Keywords: esophageal dilatation, endoscopic dilation, anastomotic stricture, caustic injury, esophageal web, lye water, hydrostatic balloon, Maloney dilation, Tucker string-guided dilation