Fluoroscopic guided benign oesophageal stricture dilatation in children: 12 years’ experience

Abstract

Background. Benign oesophageal strictures (BOSs) are a debilitating health concern in the paediatric populations of developing countries, which lead to impaired weight gain. Various non-surgical methods may be used to address these strictures.

Objectives. To compare the success and complications of fluoroscopically guided Savary-Gilliard bougienage (SGB) with balloon dilatation and the combination of both methods for the treatment of BOSs in children at Universitas Hospital, Bloemfontein, South Africa.

Methods. A retrospective review of the patient notes on all children ≤12 years who underwent oesophageal dilatation for benign strictures from January 2001 to June 2012 was performed. Interventional radiologists performed the dilatations on children under general anaesthesia either by angioplasty balloon, SGB or a combination of both. Postdilatation contrast swallows were done to confirm the absence of perforation.

Results. A total of 432 oesophageal dilatations was performed on 63 children aged ≤12 years. Of these, 36 were males (57%), and 71% were exclusive balloon dilatation, 19% exclusive SGB and 10% utilised both techniques. Five dilatations failed (1.2%) and no complications were documented. Average follow-up dilatations needed per procedure were 8.3 after SGB, 7.2 after balloon dilatation, and 4.2 after a combined method (p<0.05). Strictures due to caustic ingestion required, on average, more dilatations (n=11) compared with those in oesophageal atresia (n=6). 

Conclusion. Fluoroscopically guided dilatation of benign oesophageal strictures by either balloon catheter dilatation or SGB or a combination of the two methods is a safe and effective treatment in our paediatric population.