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      Balloon Dilatation for Corrosive Esophageal Strictures in Children: Radiologic and Clinical Outcomes

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          Abstract

          Objective

          We retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture.

          Materials and Methods

          The study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5).

          Results

          A total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD.

          Conclusion

          Only a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management.

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          Most cited references30

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          Endoscopic balloon dilatation of esophageal strictures in infants and children: 17 years' experience and a literature review.

          Whereas endoscopic balloon dilatation (EBD) of benign esophageal strictures is an established mode of therapy 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. 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. 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 perforations (1.5%) were observed, but only one required surgical repair because of persistent leakage. The remaining patients have undergone long-term follow-up (median follow-up, 6.6 years), and all are asymptomatic. This large series has shown that EBD can provide a safe and effective mean of relieving esophageal strictures with good long-term results.
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            Caustic esophageal strictures in children: 30 years' experience.

            Many children in developing countries continue to sustain caustic esophageal injures. The first line of treatment is dilatation, unless contraindicated, where 60% to 80% success rate is expected. In cases of failure, esophageal replacement is the only hope for achieving normal swallowing. Over the last 30 years, more than 850 cases of esophageal replacement were done in the Pediatric Surgery Department at Ain-Shams University. Three types of replacement were performed, gastric pull-up (75 cases), retrosternal colon replacement (550 cases), and, in the last 12 years, transhiatal esophagectomy with posterior mediastinal colon replacement (225 cases). Complications in the last 475 cases include 10% cervical leakage, 5% proximal strictures, 2% postoperative intestinal obstruction, 1% mortality, and 0.6% late graft stenosis. Colonic replacement of the esophagus is the ideal treatment in cases of caustic esophageal strictures after failure of dilatation. The posterior mediastinal route is shorter, and in long-term follow-up results show improved evacuation and less reflux than with the retrosternal route.
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              Corrosive esophagitis in children.

              We evaluated the outcome and optimal management of corrosive esophagitis in 24 children (male:female=8:16, mean age 5.0+/-5.4 years old, ranged from 15 months to 18 years of age) from January 1984 to July 2001. In 20 patients this was the result of accidental ingestion, 4 were suicide attempts and 15 patients (63%) were below 3 years of age. The ingested substances included alkali (n=17, 71%), acid (n=6, 25%), and neutral detergent (n=1, 4%). The "dumpling alkaline oil", a traditional food additive used in Taiwan, was the most common culprit in this study. A total of 9 patients ingested the dumpling alkaline oils, which comprised 38% of the total 24 patients and 53% of the 17 alkaline ingestion accidents. Of the patients 21 (88%) suffered from esophageal injury, and 15 among these 21 patients developed esophageal strictures. Esophageal strictures occurred in all patients with second or third-degree burns. Of these 15 patients with esophageal strictures, 9 (60%) received endoscope-associated dilatation and 6 (40%) underwent an operation (esophagectomy and intestinal interposition). The 9 patients who did not develop esophageal strictures had good body weight gain without feeding difficulty (functionally normal recovery). On the other hand, among the 15 patients with esophageal strictures, 9 patients had functionally subnormal recovery and 6 patients had poor recovery with either frequent feeding difficulty or growth retardation. In conclusion, accidental ingestion of alkaline oil is the most common cause of corrosive esophagitis in Taiwan. The degree of burns correlated with stricture formation.
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                Author and article information

                Journal
                Korean J Radiol
                KJR
                Korean Journal of Radiology
                The Korean Society of Radiology
                1229-6929
                2005-8330
                Mar-Apr 2010
                22 February 2010
                : 11
                : 2
                : 203-210
                Affiliations
                Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC, Seoul 110-744, Korea.
                Author notes
                Address reprint requests to: Woo Sun Kim, MD, Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC, 101 Daehangro, Jongno-gu, Seoul 110-744, Korea. Tel. (822) 2072-2814, Fax. (822) 747-5781, kimws@ 123456radcom.snu.ac.kr
                Article
                10.3348/kjr.2010.11.2.203
                2827784
                20191068
                9ec81357-a6eb-40f0-af89-f23633d65021
                Copyright © 2010 The Korean Society of Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 September 2009
                : 20 November 2009
                Categories
                Original Article

                Radiology & Imaging
                children,esophageal stricture,balloon dilatation,esophagus,dysphagia,corrosive esophagitis

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