Fluoroscopic Balloon Dilation of Esophageal Atresia Anastomotic Strictures in Children and Young Adults: Single-Center Study of 103 Consecutive Patients from 1999 to 2011

被引:21
作者
Thyoka, Mandela [1 ,3 ]
Barnacle, Alex [2 ]
Chippington, Samantha [2 ]
Eaton, Simon [1 ]
Drake, David P. [3 ]
Cross, Kate M. K. [3 ]
De Coppi, Paolo [1 ,3 ]
Kiely, Edward M. [3 ]
Pierro, Agostino [1 ,3 ]
Curry, Joseph I. [3 ]
Roebuck, Derek J. [2 ]
机构
[1] UCL, Inst Child Hlth, Surg Unit, London WC1N 1EH, England
[2] Great Ormond St Hosp Sick Children, Dept Radiol, London WC1N 3JH, England
[3] Great Ormond St Hosp Sick Children, Dept Surg, London WC1N 3JH, England
关键词
SURGICAL REPAIR; DILATATION; EXPERIENCE; SECONDARY;
D O I
10.1148/radiol.13122184
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: To determine whether fluoroscopic balloon dilation (FBD) is a safe and effective method of treating esophageal anastomotic stricture after surgical repair in an unselected patient population. Materials and Methods: With ethics committee approval, records for 103 consecutive patients who underwent FBD with our interventional radiology service (1999-2011) were reviewed retrospectively. Patients underwent diagnostic contrast materialenhanced study prior to the first dilation. Dilations were performed by using general anesthesia. Outcomes were number and/or frequency of dilations, clinical effectiveness and response to dilations, esophageal perforation, requirement for surgery, and mortality. Data were expressed as mean 6 standard deviation (with range). Comparisons were conducted by using the Fisher exact test and log-rank test. The significance level was set at P,.05. Results: One hundred three patients (61 male patients, 59%) underwent 378 FBD sessions (median, two dilations per patient; range, 1-40 dilations). The median age at first FBD was 2.2 years (range, 0.1-19.5 years). The balloon catheter diameters ranged from 4 to 20 mm. FBD was successful in 93 patients (90%): 44 (47%) after single dilation and 49 (53%) after multiple dilations. There was no difference in the proportion of patients who required one dilation and were younger than 1 year versus those who were 1 year of age and older (P > .99; odds ratio, 1.07 [range, 0.43-2.66]). Ten patients (10%) required further procedures: Three underwent stent placement, three underwent esophageal stricture resection, and four underwent esophageal reconstruction. Four esophageal perforations (1%) developed after FBD. Antireflux surgery was performed in 18 patients (17%). There were no deaths. Conclusion: FBD for anastomotic strictures after esophageal atresia repair is feasible and acceptably safe and provides relief of symptoms in most patients (90%); however, about half require more than one dilation, and surgery is best predicted if more than 10 dilations are required.
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页码:596 / 601
页数:6
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