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Experience with esophageal dilatations in children

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Author(s): G. Christopoulos-Geroulanos .

Journal: Annals of Gastroenterology
ISSN 1108-7471

Volume: 16;
Issue: 2;
Date: 2007;
Original page

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
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