Sistema gastrointestinal y digestivo

Abstracto

Balloon or Bougienage Dilation for Esophageal Stenosis in Children?

Adi Gurfinkel, Amir Ben-Tov, Isaac Kori, Hagith Nagar, Itzhak Vinograd, Shimon Reif, Shlomi Cohen

Purpose: Esophageal stenosis (ES) in children is defined as a fixed intrinsic narrowing of the esophagus caused by numerous etiologies. Treatment mainly consists of intraluminal dilation using balloon or Savary-Gilliard bougies. Methods: We retrospectively reviewed all medical records of children with ES treated by balloon or bougies. Our aim of this study was to compare both method of esophageal dilation in terms of safety, short- and long-term outcome. Results: Forty-two children were included in this study, 22 males (52%), mean age at diagnosis was 3.9 ± 5.7 years. This group underwent 190 dilation procedures in our institution between 1994-2013. The median treatment period was 5.5 months and the median follow-up after the last dilation was 2.25 years. The average number of dilations was 4.5 (range 1-22). Twenty-four patients had anastomotic stricture after surgical treatment of esophageal atresia (57.1%), 8 had stenosis following caustic ingestion (19%), 3 had functional stenosis due to esophageal motility disorders (achalasia) (7.1%) and the others (16.7%) had congenital ES, eosinophilic esophagitis, foreign body ingestion, or were post-fundoplication. Dilations were defined as failures in 11 children (26.2%). The success rate was 87% for the bougienage group (13 children) and 67% for the balloon group (18 children) (p=NS). The success rate was 75% (24 children) after caustic ingestion and surgical correction of esophageal atresia. There were 6 (3.1%) procedure-related complications that included 2 cases of aspiration pneumonia and 4 esophageal perforations. Conclusions: Esophageal dilation in children is a safe procedure with a high rate of long-term success. Longterm success of dilation among children with ES depends primarily on the etiology of stenosis and less on the method of dilation.