U Poddar1, B R Thapa. 1. Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Abstract
BACKGROUND: Little information is available regarding the safety and efficacy of dilation of esophageal strictures in children with Savary-Gilliard bougies. This is a report of our experience with this form of dilation in Indian children. METHODS: One hundred seven Indian children age 14 years or younger with benign esophageal strictures underwent dilation. Clinical information including etiology was recorded. Dilation was performed at 2- to 3-week intervals by using Savary-Gilliard bougies under ketamine sedation and was considered adequate if the esophageal lumen could be dilated to 15 mm diameter (12.8 mm in children <5 years of age) with complete relief of symptoms. Subsequently, dilation was performed on an "as needed" basis. RESULTS: Mean age was 4.8 +/- 3.4 years; male to female ratio was 3:1. Fifty-four children had corrosive strictures (acid 34, alkali 20). Noncorrosive strictures were sclerotherapy-induced (23), postsurgical (14), congenital (10), peptic (4), and due to other causes (2). Dilation was successful in all but 3 cases. Corrosive strictures required a significantly higher number of sessions to achieve adequate initial dilation (2.4 +/- 1.9 vs. 1.3 +/- 0.5, p < 0.01). Patients with corrosive strictures also required a higher number of subsequent sessions for recurrence (7.3 +/- 6.5 vs. 0.7 +/- 1.3, p = 0.10). Dilation was also successful in patients with strictures 5 cm or more in length and/or patients with multiple corrosive strictures, although these required a higher number of sessions to achieve adequate dilation (p < 0.05) and also higher number of subsequent sessions for recurrence. Six esophageal perforations occurred during 648 dilation sessions (0.9%); 5 occurred in patients with corrosive strictures. One patient required surgery. CONCLUSIONS: Corrosive injury is the most common cause of benign esophageal strictures in Indian children. Savary-Gilliard bougie dilation is safe and effective, even for long and/or multiple corrosive strictures.
BACKGROUND: Little information is available regarding the safety and efficacy of dilation of esophageal strictures in children with Savary-Gilliard bougies. This is a report of our experience with this form of dilation in Indian children. METHODS: One hundred seven Indian children age 14 years or younger with benign esophageal strictures underwent dilation. Clinical information including etiology was recorded. Dilation was performed at 2- to 3-week intervals by using Savary-Gilliard bougies under ketamine sedation and was considered adequate if the esophageal lumen could be dilated to 15 mm diameter (12.8 mm in children <5 years of age) with complete relief of symptoms. Subsequently, dilation was performed on an "as needed" basis. RESULTS: Mean age was 4.8 +/- 3.4 years; male to female ratio was 3:1. Fifty-four children had corrosive strictures (acid 34, alkali 20). Noncorrosive strictures were sclerotherapy-induced (23), postsurgical (14), congenital (10), peptic (4), and due to other causes (2). Dilation was successful in all but 3 cases. Corrosive strictures required a significantly higher number of sessions to achieve adequate initial dilation (2.4 +/- 1.9 vs. 1.3 +/- 0.5, p < 0.01). Patients with corrosive strictures also required a higher number of subsequent sessions for recurrence (7.3 +/- 6.5 vs. 0.7 +/- 1.3, p = 0.10). Dilation was also successful in patients with strictures 5 cm or more in length and/or patients with multiple corrosive strictures, although these required a higher number of sessions to achieve adequate dilation (p < 0.05) and also higher number of subsequent sessions for recurrence. Six esophageal perforations occurred during 648 dilation sessions (0.9%); 5 occurred in patients with corrosive strictures. One patient required surgery. CONCLUSIONS:Corrosive injury is the most common cause of benign esophageal strictures in Indian children. Savary-Gilliard bougie dilation is safe and effective, even for long and/or multiple corrosive strictures.
Authors: Raf Bisschops; Miguel Areia; Emmanuel Coron; Daniela Dobru; Bernd Kaskas; Roman Kuvaev; Oliver Pech; Krish Ragunath; Bas Weusten; Pietro Familiari; Dirk Domagk; Roland Valori; Michal F Kaminski; Cristiano Spada; Michael Bretthauer; Cathy Bennett; Carlo Senore; Mário Dinis-Ribeiro; Matthew D Rutter Journal: United European Gastroenterol J Date: 2016-08-21 Impact factor: 4.623