Long-Term Outcomes of Caustic Esophageal Stricture with Endoscopic Balloon Dilatation in Chinese Children.

Shunxian Cheng,Cui-Ping Liang,Zhao-Hui Xu,Ding-You Li,Lu Ren,Lan-Lan Geng,Hong-Li Wang,Min Yang,Li-Ying Liu,Chao Zhang,Yang Chen,Wan-Fu Xu,Hui-Wen Li,Qiang Wu,Si-Tang Gong,Pei-Yu Chen

doi:10.1155/2018/8352756

Abstract

Caustic esophageal stricture (CES) in children still occurs frequently in developing countries. We aimed to evaluate the long-term outcomes of endoscopic balloon dilatation (EBD) in treating CES in children and the influencing factors associated with outcome. We retrospectively reviewed the data of all patients who had a diagnosis of CES and underwent EBD from August 1, 2005, to December 31, 2014. The primary outcome was EBD success, which was defined as the maintenance of dysphagia-free status for at least 12 months after the last EBD. The secondary outcome was to analyze influencing factors associated with EBD success. Forty-three patients were included for analysis (29 males; mean age at first dilatation 44 months with range 121 months). 26 (60.5%) patients had long segment (>2 cm) stricture. A total of 168 EBD procedures were performed. Twenty-six (60.5%) patients were considered EBD success. Seventeen (39.5%) patients failed EBD and required stent placement and/or surgery. Patients in the EBD success group had significantly shorter stricture segments when compared to the EBD failure group (t = 2.398, P = 0.018, OR = 3.206, 95% OR: 1.228–8.371). Seven (4.4%) esophageal perforations occurred in 6 patients after EBD. Stents were placed in 5 patients, and gastric tube esophagoplasty was performed in 14 patients. In conclusion, 26 (60.5%) of 43 children with CES had EBD success. Length of stricture was the main influencing factor associated with EBD treatment outcome.

Highlights

Caustic esophageal stricture (CES) in children still occurs frequently in developing countries, due to accidental ingestion of caustic substances including strong alkalis and acids [1, 2]
3 patients were admitted to our hospital immediately after caustic substance ingestion, and all others were referred to our hospital for dysphagia after the acute phase
Esophageal balloon dilatation has been recommended as the choice of treatment for esophageal stricture in children

Summary

Introduction

Caustic esophageal stricture (CES) in children still occurs frequently in developing countries, due to accidental ingestion of caustic substances including strong alkalis and acids [1, 2]. The rate of esophageal stricture formation after caustic ingestion is reported to be between 2% and 63% [3,4,5]. Current management for CES includes esophageal dilatation, retrievable stent placement, surgical resection of short segment stricture, and esophageal replacement. Dilatation has been considered as the treatment of choice for CES and can be performed endoscopically or fluoroscopically, using a balloon dilator or rigid dilator [6]. Several case series reports have shown that endoscopic balloon dilatation (EBD) is a safe and effective treatment for children with CES [7, 8].

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Conclusion