Anastomotic strictures following esophageal atresia repair: a 20-year experience with endoscopic balloon dilatation

Abstract

Objectives: The aim of the study was to evaluate the safety, effectiveness, and long-term results of endoscopic balloon dilatation in children with anastomotic strictures following esophageal atresia (EA) repair.

Patients and methods: From January 1988 to January 2008, 59 patients were treated with balloon dilatation for anastomotic stricture following EA repair. Indication for dilatation was dysphagia of varying degree. Outcome parameters included the number of dilatations, response to dilatation, effectiveness, and complications. Response to dilatation was considered excellent when there was no need for any additional dilatation for recurrent dysphagia, satisfactory when up to 5 dilatations were required, and fair when >5 sessions were required. The treatment was considered effective when dysphagia was grade 0 or 1 for >12 months after the last dilatation session.

Results: A total of 165 balloon dilatations were undertaken, with an average of 279 per patient (range 1-9). Age range at diagnosis was 1 to 36 months (mean 10.5). Response to dilatation was excellent in 21 cases (35.6%), satisfactory in 26 (44.1%), and fair in 12 (20.3%). The treatment was effective in 47 patients (79.7%) and ineffective in 12 (20.3%). The median follow-up period was 19.5 months. Four patients underwent surgery; in 1 patient a retrievable stent was placed. No perforation occurred.

Conclusions: Endoscopic balloon dilatation can be accomplished safely and effectively as a first-line therapy for the management of anastomotic strictures following EA repair.