Balloon dilatation for corrosive esophageal strictures in children: radiologic and clinical outcomes

Abstract

Objective: We retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture.

Materials and methods: The study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5).

Results: A total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD.

Conclusion: Only a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management.

Keywords: Balloon dilatation; Children; Corrosive esophagitis; Dysphagia; Esophageal stricture; Esophagus.

Fig. 1

2-year-old boy with focal esophageal stricture after glacial acetic acid ingestion (patient 9) A. Initial esophagogram obtained four months after ingestion revealed severe focal stricture (arrow) in upper esophagus. B. Esophagogram obtained after esophageal balloon dilatation using 10 mm balloon catheter demonstrated improvement of stricture (arrows). Patient's feeding difficulty was substantially relieved. However, recurrent stenosis occurred after four sessions of esophageal balloon dilatation, which led to performing segmental resection and anastomosis.

Fig. 2

1-year-old girl with segmental stricture after ingesting glacial acetic acid (patient 14). A. Initial esophagogram obtained one month after ingestion of glacial acetic acid revealed segmental stricture (arrows) in upper esophagus. B. Initial esophageal balloon dilatation was performed with 8 mm balloon catheter. 'Hourglass' deformity of balloon at level of stricture was eliminated (not shown here) when inflation was maintained. C. Esophagogram obtained one month after second esophageal balloon dilatation session shows stricture recurrence (arrows). After four esophageal balloon dilatation sessions, segmental resection and anastomosis was performed.

Fig. 3

2-year-old girl with diffuse stricture after lye ingestion (patient 2). A. Initial esophagogram obtained six months after lye ingestion reveals diffuse irregular stricture of esophagus. B. Esophageal balloon dilatation was performed with 8 mm balloon catheter. Note incomplete balloon dilatation (arrows) due to presence of severe fibrotic changes. C. Esophagogram obtained after above esophageal balloon dilatation session demonstrates some improvement. D. Follow-up esophagogram obtained two weeks after esophageal balloon dilatation demonstrates diffuse restricture (arrows) in esophagus.