title: Esophageal stenosis in epidermolysis bullosum: a challenge for the endoscopist.
abstract: OBJECTIVE
  Esophageal stenosis is a severe complication in dystrophic epidermolysis bullosa (EB). Endoscopic dilations may cause mucosal injury with stricture recurrence. Our aim was to describe our referral EB-center experience on safety and long-term efficacy of fluoroscopically guided balloon dilation without endoscopy.
  
  
  METHODS
  Over 14 years, 34 patients with EB, previously evaluated with barium esophagogram for dysphagia, underwent balloon esophageal dilation. Under fluoroscopy, a guide wire was introduced via a nostril into the stomach. A 12-mm pneumatic balloon, which passed over the wire, was filled using radio-opaque contrast, dilating the stricture. Orotracheal intubation was avoided. Antibiotics, dexamethasone, and proton-pump inhibitors were administered. Study approval was obtained from our ethical board.
  
  
  RESULTS
  Ninety-three dilations were performed. Seventeen patients had a single stenosis. The mean age of onset was 18 years (range, 3-47 years). Thirteen patients underwent one dilation. In 6 cases, endoscopy was necessary to visualize the esophageal lumen. Complications included cervical esophageal perforation (2) and transitory dysphagia (10). Thirty patients were feeding within 24 hours. During the follow-up, 2 patients required a gastrostomy, and 2 patients underwent fundoplication for gastroesophageal reflux disease.
  
  
  CONCLUSIONS
  Fluoroscopically guided balloon dilation in EB is a safe and well-tolerated procedure. An experienced endoscopy team is necessary in certain cases.
authors: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy. paoladeangelis.opbg@gmail.com
authors: Paola
authors: P
authors: De Angelis
authors: Tamara
authors: T
authors: Caldaro
authors: Filippo
authors: F
authors: Torroni
authors: Erminia
authors: E
authors: Romeo
authors: Francesca
authors: F
authors: Foschia
authors: Giovanni Federici
authors: GF
authors: di Abriola
authors: Francesca
authors: F
authors: Rea
authors: May
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authors: El Hachem
authors: Elisabetta
authors: E
authors: Genovese
authors: Sandra
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authors: D'Alessandro
authors: Luigi
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