Fluoroscopic balloon dilatation for anastomotic strictures in patients with esophageal atresia: A fifteen-year single centre UK experience

Abstract

Aim of the study

To assess the safety and effectiveness of fluoroscopic balloon dilatation (FBD) in children with esophageal anastomotic stricture after surgical repair of esophageal atresia.

Methods

All patients undergoing surgery for esophageal atresia and requiring dilatation(s) during a consecutive 15-year period [April 2000–September 2014] were analyzed. Dilatations were performed as day case procedures under general anesthesia using a radial force generating balloon device (Boston Scientific Corporation) by surgeons. Outcomes assessed included – (1) the number of dilatations/patient, (2) effectiveness and (3) need for surgery and (4) complications.

Results

One hundred thirty seven patients underwent 625 FBD sessions (median 3 dilations per patient; range 1–24 dilatations). Median age at 1st FBD was 0.74 years (range 0.05–16.1 years). Balloon catheter sizes ranged from 6 mm to 20 mm. FBD yielded excellent results in 99 patients (74%), while 17 cases (13%) had mild ongoing dysphagia/dysmotility. Ten patients (7%) required further dilatation(s) to control symptoms. No patient(s) required esophageal stenting. Five cases required G-tube feeds as a result of oral aversion behavior – all of these cases were complex/VACTERL patients. Only 1 minor radiological leak occurred after a dilatation session and this did not require surgical intervention. A single patient (long gap EA TEF) with severe neurological impairment having multiple dilatations and stricture resection ultimately required esophageal replacement. Anti-reflux surgery was performed in 36 patients (26%) for medical therapy resistant GER.

Conclusion

FBD for anastomotic stricture(s) following esophageal atresia repair achieved very good outcomes for the majority of EA TEF patients. The procedure can be accomplished safely as indicated by the low complication rate herein reported. Although some children may require more than one dilatation session prompt relief of symptoms can be achieved with a vigilant care program co-ordinated by a multidisciplinary specialist EA TEF team.