Experience with esophageal dilatations in children

Abstract

SUMMARY
Aim: Esophageal stenosis requiring treatment is a serious
complication of a variety of otherwise benign conditions in
children. Dilatation is the treatment of choice. However,
the method and acceptable duration are largely a matter of
personal preference. We present our experience with 81
children undergoing dilatations for benign strictures due
to a variety of causes and discuss the resulting problems.
Material: During the period 1987-2001, eighty-one children
were treated for strictures of the esophagus. The causes
were: correction of esophageal atresia (EATEF), gastroesophageal
reflux (GER), stricture of the cerevical anastomosis
following esophageal replacement (ER), burn due to
ingestion of caustic agents (CB), tight fundoplication (TF),
achalasia (EA), congenital esophageal stenosis (CES) and
stenosis following sclerotherapy of esophageal varices (EV).
All dilatations were performed under general anesthesia.
Balloon dilatations were performed under fluoroscopic control
following endoscopic insertion of the guide-wire.
Results: The results were excellent or good in 58 children
(78.3%). Twenty-four children (25.9%) had to be treated
surgically either to stabilize the result of the dilatations or
to correct an intractable stenosis. Complications occurred
in 6 children (7.4%): Four suffered a rupture at the level of
the stricture following bougienage. Transverse suture of the
longitudinal tear resulted in cure of the stenosis in 3. In
the fourth, a cervical esophagostomy and gastrostomy had
to be placed. Finally one child had a subdiaphragmatic rupture
at the esophago-gastric junction, also following bougienage, treated with drainage. Strictures following
esophageal replacement required the most dilatations
(mean 11.3 per patient). An increased number of procedures
were also required in esophageal burns (mean 6.3).
Conclusion: 1) Esophageal dilatation is an effective treatment
for strictures. 2) Rupture is a serious complication
best treated surgically. 3) Transverse suture of a longitudinal
tear results in resolution of the stenosis. 4) GER, whenever
present, should be treated to preserve the result of the
treatment.
Key words: esophageal stenosis, dilatation, children