Endoscopic Balloon Dilatation of Esophageal Strictures in Infants and Children: 17 Years’ Experience and a Literature Review By L.C.L. Lan, K.K.Y. Wong, S.C.L. Lin, A. Sprigg, S. Clarke, P.R.V. Johnson, and P.K.H. Tam Hong Kong, China Purpose: Whereas endoscopic balloon dilatation (EBD) of benign esophageal strictures is an established mode of ther- apy in adults, this has not been accepted universally in the pediatric population. The aim of this study is to report the safety, efficacy, and long-term results of EBD for children in the authors’ center. Methods: Between 1986 and 2002, a total of 77 children (median age, 1.8 years; range, 2 months to 20 years) were treated by EBD for various causes: 2 had achalasia, and 75 had esophageal strictures (postesophageal atresia repair, 63; reflux esophagitis, 7; postfundoplication, 2; caustic injury, 3). Dilatations were performed using flexible endoscopy and fluoroscopic screening under general anesthesia. Results: A total of 260 dilatations were carried out with the mean number of EBD per patient being 3.4 (range, 1 to 19). A mean period of 5 months (maximum, 28 months) for each patient was required. Four complications of esophageal per- forations (1.5%) were observed, but only one required sur- gical repair because of persistent leakage. The remaining patients have undergone long-term follow-up (median fol- low-up, 6.6 years), and all are asymptomatic. Conclusions: This large series has shown that EBD can pro- vide a safe and effective mean of relieving esophageal stric- tures with good long-term results. J Pediatr Surg 38:1712-1715. © 2003 Elsevier Inc. All rights reserved. INDEX WORDS: Esophageal strictures, endoscopic balloon dilatation, outcome. E SOPHAGEAL STRICTURES in children may oc- cur after surgery for congenital esophageal atresia or as complications from reflux esophagitis, caustic in- gestion, or restrictive Nissen fundoplication. 1 The initial treatment usually is intraluminal dilatations, and surgery is reserved for those unresponsive to repeated dilatations. Although bougienage traditionally has been used in the dilatation of esophageal strictures, 2-4 balloon catheter dilatation now is increasingly accepted as a treatment modality in the adult population. 5-7 Since London et al 8 reported the treatment of esophageal strictures with a Gruentzig-type balloon catheter, balloon dilatation also has been introduced for use in some pediatric centers. This practice, however, is not universally accepted, and large series reporting the safety and efficacy of balloon dilatation for the treatment of esophageal strictures in infants and children have been rare to date. One theoret- ical advantage of balloon catheter dilatation is that the stricture is dilated gradually by a uniform radial force determined by the inflation of the balloon. In contrast, bougienage exerts an abrupt shearing axial force that often causes significant injury of the mucosa and may therefore lead to scars and further stricture. 9,10 We have reported previously our preliminary experience on the use of endoscopic balloon dilatation (EBD) without fol- low-up data. 11 In addition, we now aim to detail the long-term results of a large series of 77 patients over a 17-year period after initial successful balloon dilatation. This will be reviewed together with other series to date. MATERIALS AND METHODS Between July 1984 and December 2002, a total of 77 patients with esophageal strictures were treated by the corresponding author or under his supervision in 3 centers consecutively (33 in Royal Liverpool Children’s Hospital, Alder Hey, UK; 19 in John Radcliffe Hospital, Oxford, UK; and 25 in Queen Mary Hospital, Hong Kong). All children suspected of having esophageal stricture with symptoms of excessive drooling, regurgitation of food substance, decreasing tolerance of the caliber of food particles, or dysphagia were assessed with a contrast study to evaluate the location and diameter of the stricture. Flexible upper gastrointestinal endoscopy was performed under general anesthesia using Olympus GIF XQ230, XP 240, or N30 (Olympus Optical Co. Ltd, Tokyo, Japan). The “rule of thumb” guide (the size of the patient’s esophagus is approximately the size of the patient’s own thumb) was used as a rough guide to choosing the balloon catheter size. 11 The balloon catheters used were Maxforce TTS or CRE (Control radial expansion; Boston Scientific Corp, Watertown, MA). The balloon catheter then is passed through the working channel of the endoscope (Maxforce TTS) or in the case of a tight stricture, a From the Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China. Presented at the 36th Annual Meeting of the Pacific Association of Pediatric Surgeons, Sydney, Australia, May 12-16, 2003. Address reprint requests to Professor Paul Tam, Division of Paedi- atric Surgery, Department of Surgery, University of Hong Kong Med- ical Centre, Queen Mary Hospital, Pok Fu Lam Road, Hong Kong SAR, China. © 2003 Elsevier Inc. All rights reserved. 0022-3468/03/3812-0003$30.00/0 doi:10.1016/j.jpedsurg.2003.08.040 1712 Journal of Pediatric Surgery, Vol 38, No 12 (December), 2003: pp 1712-1715