title: Fluoroscopic balloon dilatation for caustic esophageal stricture in children: an 8-year experience.
abstract: OBJECTIVE
  Esophageal balloon dilatation (EBD), when performed early and correctly, can efficiently treat caustic esophageal stricture (ES). Herein, we present 8 years of experience treating caustic ES, and discuss the technique as well as the complications.
  
  
  METHODS
  We retrospectively reviewed the medical records of 38 children in whom we performed fluoroscopic EBD under general anesthesia for caustic ES between November 2004 and November 2012 in our hospitals. The patients were grouped into the early dilatation group, who began EBD earlier (mean, 15 days) after caustic ingestion, and the late dilatation group who was referred later (mean, 34 days) for EBD by other centers. The ESs were classified into short and long strictures. Balloon size was increased gradually to a sufficient diameter over consecutive sessions. Characteristics of patients and ES, details of the EBD, and treatment results were analyzed.
  
  
  RESULTS
  A total of 369 EBD sessions were successfully performed in 38 children (aged 14 months to 14 years, median 3.5 years). In six patients, EBD treatments are continuing, one patient was lost to follow up, one patient who received a stent was excluded, and three returned to their previous centers. The remaining 27 patients were treated successfully by repeated EBD treatments. Nevertheless, in the early dilatation group (n=16), EBD treatment was significantly faster and shorter than that in the late dilatation group (n=11). In addition, the short stricture treatment was also of significantly shorter duration than the long stricture treatment. Six (1.6%) esophageal perforations occurred in five patients (13.2%); all were treated conservatively. There was no mortality.
  
  
  CONCLUSIONS
  For treatment of caustic ES, fluoroscopically guided EBD is safe and has a low rate of complications as well as a 100% success rate. However, it should be begun earlier, and in children, should be performed gently with balloons of gradually increasing appropriate diameters over consecutive sessions.
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey. Electronic address: iuygun@hotmail.com.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Uygun
authors.forename: Mehmet Serif
authors.initials: MS
authors.lastname: Arslan
authors.forename: Bahattin
authors.initials: B
authors.lastname: Aydogdu
authors.forename: Mehmet Hanifi
authors.initials: MH
authors.lastname: Okur
authors.forename: Selcuk
authors.initials: S
authors.lastname: Otcu
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002057:Burns, Chemical / Q000473:pathology / Q000628:therapy*; D002424:Caustics / Q000633:toxicity*; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004106:Dilatation / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005471:Fluoroscopy; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007223:Infant; D064747:Lansoprazole / Q000627:therapeutic use; D008297:Male; D015641:Radiography, Interventional / Q000379:methods* / Q000706:statistics & numerical data; D011899:Ranitidine / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D002424:Caustics; D064747:Lansoprazole; D002443:Ceftriaxone; D011899:Ranitidine
keywords: Balloon dilatation; Caustic; Corrosive; Esophageal stricture; Fluoroscopy