Clinical outcome of endoscopic balloon dilatations employed in benign paediatric oesophageal pathologies

Abstract

Background: Oesophageal dilatations can be done either by bougies or balloons for differing aetiologies in children. We investigated the efficacy and safety of endoscopic balloon dilatations (EBDs) employed by a single surgeon.

Patients and methods: Relevant data over 12 years were retrospectively evaluated with an ethical committee approval.

Results: Ninety-seven children underwent 514 EBD with a median EBD of 3 (1-50). The primary diagnoses were oesophageal atresia (OA) in 51 children, corrosive ingestion in 21, peptic strictures in 13, achalasia in 8 and congenital oesophageal stenosis in 4. The balloon size varied between 3 and 30 mm. The EBD was successfully ended in 72 patients and unsuccessful in six patients. Six children are still under EBD and 13 are lost to follow-up. The overall success rate was 92%. The age at the time of first dilatation was the youngest in OA group followed by corrosive strictures. The balloon sizes differed regarding the age of the patients with larger balloons used as the patient age increased. The sizes of the balloons used at the first and the last EBD differed among diagnostic groups. The total number of dilatations or the time interval between the first and the last EBD dilatation did not show a statistically significant difference among groups. The anatomical type of OA or the height of corrosive stricture revealed no significant difference in any of the above parameters. A transmural oesophageal perforation occurred during 2 (0.4%) EBD sessions.

Conclusions: EBD is an effective mean in relieving paediatric oesophageal pathologies with a variety of aetiologies and has a low complication rate.

Keywords: Balloon dilatation; corrosive ingestion; endoscopy; oesophageal atresia; stricture.

Figure 1

Oesophageal balloon dilatation catheter with three distinct sizes which can be reached by specifically indicated pressure limits on the label. These balloons enable increasing the size during a single dilatation session. The one in the figure can be used for 8 mm, 9 mm or 10 mm dilatations at respective pressures of 3 ATM, 5.5 ATM and 9 ATM. The arrow indicates the balloon on the catheter. (a). The balloon (arrow) is wire-guided (*) and can therefore be used either by through-the-scope or over-the wire technique. (b). A balloon inflation manometer syringe is used to measure the pressure reached during dilatation. The inflated balloon on the catheter is indicated with an arrow. (c)

Figure 2

Endoscopic appearance of a stricture in a patient with primarily repaired oesophageal atresia (a). Fluoroscopic images of the same patient obtained during sequential dilatations by using an 8 mm (b), 10 mm (c) and 12 mm. (d) catheter over a course of 2 months. The proximal end of a corrosive stricture as visualised by endoscopy. (e). The length of the stricture was 2 vertebral bodies and the balloon catheter was inflated up to a diameter of 13 mm (f-h)