Efficacy of bougie versus balloon dilatation in children with benign esophageal stricture: a propensity score–matched retrospective cohort study

Abstract

Background and AimsEndoscopic dilatation is the primary management of esophageal strictures in children. However, pediatric data on which of the two endoscopic techniques, bougie or balloon, is better, and the effect of endoscopic dilatation on the growth of children is lacking. We aimed to evaluate (i) whether bougie or balloon dilatation is superior in efficacy and safety for short esophageal strictures in children and (ii) the impact of endoscopic dilatation on their growth. MethodsWe performed endoscopic dilatation every 2 to 3 weekly using either a bougie or balloon and considered it adequate if we could dilate the esophageal lumen to 15 mm (11mm in < 2 years, 12mm in 2-5years of age) with complete relief of symptoms for >2 months. ResultsTwo-fifty-nine children were enrolled, with 2580 dilatations performed during the study. We performed a comparative analysis on 77 children where an exclusive bougie versus balloon dilatation was carried out for short strictures (defined as stricture length <5cm). Both bougie and balloon showed similar efficacy [sessions for adequate dilatation: 5 (2.5-7.5) vs. 4 (2-6), p=0.40] and safety [perforation rate; 0.54% vs. 0.35%, p=0.591] for short strictures. On follow-up (median of 17 months), there was a significant improvement in both weight and height z-scores in children with successful dilatation. ConclusionsEndoscopic bougie and balloon dilatations were safe and effective, with no significant difference for short strictures. Successful dilatation resulted in significant improvement in growth on follow-up.