Balloon Dilation is Preferable to Bougienage in Children with Esophageal Atresia

Background and Study Aims: Esophageal strictures are a common problem after surgical repair in children with esophageal atresia. The traditional procedure in these patients is dilation using bougie dilators, usually controlled fluoroscopically or endoscopically. Nowadays, an alternative technique is balloon-catheter dilation. The aim of this study was to report our experience with pneumatic balloon dilation and to compare this method with previously performed bougienage with regard to efficacy.

Patients and Methods: Over 16 years, 34 patients who developed symptomatic strictures were encountered at our institution. In the first 9 years 12 patients underwent 178 bougienages (group C). In the last 7 years six patients who had undergone 202 previous bougienages (group B), and 16 patients who had undergone no bougienages (group A), underwent 52 dilations. The dilation was carried out under intravenous sedation using a combination of midazolam and etomidate. The balloon was placed in the stricture endoscopically and the procedure was performed under fluoroscopic and endoscopic control.

Results: In all patients the dilation was effective and involved minimal trauma. The strictures required 1 to 7 procedures (median 2) over a maximum of 18 months (median 3 months) for a good treatment result. The complications observed were two perforations, one of them with pneumothorax (both treated conservatively), and two compressions of the trachea (interruption of the procedure, but efficient dilation was eventually achieved). The method was more effective than bougienage (1 to 60 bougienages were required per patient, median 9).

Conclusions: Compared with traditional bougienage, balloon dilation of esophageal strictures is less traumatic and more effective. Complications are rare and can be managed conservatively. In our opinion this procedure is the appropriate treatment for strictures, even in very small infants, after repair of esophageal atresia.

References

• 1 Auldist A W, Beasley S W. Oesophageal complications. In: Beasley SW, Myers NA, Auldist AW (eds). Oesophageal atresia.  London; Chapman & Hall, 1991: 305-329
• 2 Orenstein S R, Whitington P F. Esophageal stricture dilatation in awake children.  J Pediatr Gastroenterol Nutr. 1985;  4 557-562
• 3 Dalzell A M, Shepherd R W, Cleghorn G J, Patrick M K. Esophageal stricture in children: fiber-optic endoscopy and dilatation under fluoroscopic control.  J Pediatr Gastroenterol Nutr. 1992;  15 426-430
• 4 Ball W S, Strife J L, Rosenkrantz J, et al. Esophageal strictures in children. Treatment by balloon dilatation.  Radiology. 1984;  150 263-264
• 5 Shah M D, Berman W F. Endoscopic balloon dilatation of esophageal strictures in children.  Gastrointest Endosc. 1993;  39 153-156
• 6 Tam P KH, Sprigg A, Cudmore R E, et al. Endoscopy-guided balloon dilatation of esophageal strictures and anastomotic strictures after esophageal replacement in children.  J Pediatr Surg. 1991;  26 1101-1103
• 7 Johnsen A, Ingemann-Jensen L, Mauritzen K. Balloon-dilatation of esophageal strictures in children.  Pediatr Radiol. 1986;  16 388-391
• 8 Myer C M, Ball W S, Bisset G S. Balloon dilatation of esophageal strictures in children.  Arch Otolaryngol Head Neck Surg. 1991;  117 529-532
• 9 Allmendinger N, Hallisey M J, Markowitz S K, et al. Balloon dilatation of esophageal strictures in children.  J Pediatr Surg. 1996;  31 334-336
• 10 Behrens R, Seiler A, Rupprecht T, Lang T. Sedierung versus Allgemeinnarkose in der pädiatrischen Endoskopie.  Klin Pädiatr. 1993;  205 158-161
• 11 Lisý J, Hetková M, :Snajdauf J, et al. Long term outcomes of balloon dilatation of esophageal strictures in children.  Acad Radiol. 1998;  5 832-835
• 12 Kang S-G, Song H-Y, Lim M-K, et al. Esophageal rupture during balloon dilatation of strictures of benign or malignant causes: prevalence and clinical importance.  Radiology. 1998;  209 741-746