Elsevier

Journal of Pediatric Surgery

Volume 48, Issue 11, November 2013, Pages 2230-2234
Journal of Pediatric Surgery

Original Article
Fluoroscopic balloon dilatation for caustic esophageal stricture in children: An 8-year experience

https://doi.org/10.1016/j.jpedsurg.2013.04.005Get rights and content

Abstract

Purpose

Esophageal balloon dilatation (EBD), when performed early and correctly, can efficiently treat caustic esophageal stricture (ES). Herein, we present 8 years of experience treating caustic ES, and discuss the technique as well as the complications.

Methods

We retrospectively reviewed the medical records of 38 children in whom we performed fluoroscopic EBD under general anesthesia for caustic ES between November 2004 and November 2012 in our hospitals. The patients were grouped into the early dilatation group, who began EBD earlier (mean, 15 days) after caustic ingestion, and the late dilatation group who was referred later (mean, 34 days) for EBD by other centers. The ESs were classified into short and long strictures. Balloon size was increased gradually to a sufficient diameter over consecutive sessions. Characteristics of patients and ES, details of the EBD, and treatment results were analyzed.

Results

A total of 369 EBD sessions were successfully performed in 38 children (aged 14 months to 14 years, median 3.5 years). In six patients, EBD treatments are continuing, one patient was lost to follow up, one patient who received a stent was excluded, and three returned to their previous centers. The remaining 27 patients were treated successfully by repeated EBD treatments. Nevertheless, in the early dilatation group (n = 16), EBD treatment was significantly faster and shorter than that in the late dilatation group (n = 11). In addition, the short stricture treatment was also of significantly shorter duration than the long stricture treatment. Six (1.6%) esophageal perforations occurred in five patients (13.2%); all were treated conservatively. There was no mortality.

Conclusions

For treatment of caustic ES, fluoroscopically guided EBD is safe and has a low rate of complications as well as a 100% success rate. However, it should be begun earlier, and in children, should be performed gently with balloons of gradually increasing appropriate diameters over consecutive sessions.

Section snippets

Patients and methods

We retrospectively reviewed 369 EBD sessions using fluoroscopically guided EBD to treat 38 children with caustic ES between November 2004 and November 2012 at Kutahya Evliya Celebi Government Hospital and Dicle University Hospital. All EBDs were performed by a single surgeon who worked at both centers. The patients were classified into the early dilatation group, who was treated with earlier EBD by our caustic ingestion management protocol reported previously [9], and the late dilatation group,

Results

A total of 369 EBD procedures for treatment of caustic ES were performed in 38 children. Most cases occurred after strong alkali ingestion [31 (81%) alkali, six (16%) acid, and one (3%) unknown caustic substance], nearly all of which were grease cleaners (30 grease cleaners, one drain cleaner). In most cases, the caustic substance was ingested from a non-original container (32, 84%). Follow-up was 4–96 months (median, 35 months). Patient characteristics and features of the ESs are shown in Table 1

Discussion

Fluoroscopically guided EBD is more effective and safer than endoscopic EBD [4], [5], [6], [7], [8], [9], [10]. In the literature, the success rates for fluoroscopically guided EBD in children and adults range from 64% to 100% [4], [5], [6], [8], [9], [10]. Fluoroscopically guided EBD offers numerous advantages over endoscopically guided EBD or blindly performed bougienage, particularly superior image control, and it allows visualization of the ES in its entirety (location, severity, length,

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