Balloon dilation of anastomotic strictures secondary to surgical repair of Esophageal atresia in a pediatric population: long-term results

PURPOSE: To evaluate the clinical effectiveness and long-term results of balloon dilation treatment for strictures secondary to surgical repair of esophageal atresia (EA) in 29 children. MATERIALS AND METHODS: The study involved 29 children aged 1-60 months with strictures of greater than 50% at anastomotic sites. The interval between surgical repair and balloon dilation ranged from I to 36 months (mean, 6.4 months). All procedures were performed under general anesthesia with use of fluoroscopic guidance. Balloon catheter diameters ranged from 8 mm to 16 min. Outcome parameters measured included the number of dilations, procedural success rates, primary and secondary clinical success rates, and complications such as esophageal perforation. Primary clinical success was defined as an absence of dysphagia for at least 1 year and weight gain appropriate to the patient's age after initial balloon dilation. Secondary clinical success was defined as an absence of dysphagia for at least 1 year after the final dilation and weight gain appropriate to the patient's age after one or more balloon dilation sessions. RESULTS: A total of 44 balloon dilation sessions were performed, with patients undergoing one to five dilation procedures (mean, 1.6 per patient; median, 1 per patient). Primary and secondary clinical success rates were 59% (17 of 29) and 93% (27 of 29), respectively. During the mean follow-up period of 3.1 years (range, 1-12 y), all 27 children with clinical success showed no recurring symptoms. In terms of complications, transmural perforation occurred in three children (10%), two of whom received conservative management and one of whom underwent surgery for combined esophageal rupture and esophagotracheal fistula. No mortalities occurred. CONCLUSION: Balloon dilation is a safe and effective procedure with excellent long-term results for the treatment of anastomotic strictures secondary to surgical repair of EA in a pediatric population.