Esophageal dilation through bouginage or balloon catheters in children, as the treatment of benign esophageal strictures: results, considering the etiology, and the methods

BACKGROUND: Corrosive substance ingestion, history of esophageal surgery, and reflux esophagitis are the main causes of benign esophageal strictures in children. Esophageal dilation is the first treatment option. Bougies and balloons are the most frequently used dilation tools. The literature record on esophageal dilation methods and their results is mostly composed of data gathered from adults, who differ from children in many terms, including etiology, indications, and results. This study aims to evaluate esophagial dilation in children; comparing the two mentioned modalities; and considering the impact of different diseases on dilation success. METHODS: The benign esophageal stricture cases who had undergone esophageal dilation between 2001 and 2009, at two tertiary health-care centers of a university were evaluated retrospectively with regard to stricture etiology, treatment methods, and their results. In addition, balloon and bougie dilations were compared.RESULTS: Fifty-four cases were dilated in 447 sessions. The strictures were due to corrosive ingestion or anastomoses in 72.2% of the cases. Of the dilation sessions, 52.6% were performed with Savary-Gilliard bougies, and the rest with balloon dilators. No guidewire was needed in 53.2% of the bougie sessions. Fluoroscopy was used during balloon dilation sessions as a routine part of the method, while it was needed only to check the guide location when needed during the bougie dilation sessions. The complication rates of balloon and bougie dilation sessions were 2.4% and 2.1%, respectively. The mean session length was 26.2 +/- 11.8 and 42.6 +/- 13.7 min, for bougie and balloon, respectively. Success rate was 93.7% for the balloon, while 98.2% of the bougie sessions. Balloon catheters used were disposable.CONCLUSION: Savary-Gilliard bougies have advantages over balloon catheters with less need of fluoroscopy, shorter duration of sessions, and lower cost. Both methods are equivalently safe with close complication rates.