Predictors of clinical response of esophageal dilatations in pediatric population

Abstract

IntroductionEsophageal strictures are a common condition, and pediatric surgeons confront them regularly. Despite being performed very frequently, there ared not studies that clearly identify prognostic factors for pediatric patients. MethodsMedical records of the children who were taken to esophageal dilatation due to strictures from January 2015 to December 2018 were reviewed. Statistical analysis was performed to establish prognostic factors. ResultsSix hundred sixty-three procedures were performed in 111 patients. The majority of patients had antecedent of esophageal atresia 56%, corrosive stricture in 24%, idiopathic 11%, and Gastroesophageal Reflux (GER) in 9%. The effectiveness of the dilatations was evaluated against three parameters: Dysphagia 0 or 1 in the last assessment 82%. Discharge from dilatation protocol 64%, and no need for surgery 74%. The Global effectiveness was determined by fulfilling the three previous outcomes and was of 49%. The complication rate was 1.9%, being esophageal perforation the most frequent. The statistically significant predictors for the ineffective dilations were airway compromise and history of feeding surgery. The length fewer than 2 cm of the stricture, the location in the middle third of the esophagus and the endoscope passage in the first procedure were factors associated with a better prognosis. Airway involvement was also a variable associated with more significant complications. ConclusionsEsophageal dilatations are a fundamental part of the management of strictures. This study found relevant prognostic factors for both the effectiveness of the dilatations and the complications of these. More studies are needed for a gold standard of effectiveness in this condition. Level of evidenceThis is a retrospective study of level III of evidence.