title: Fluoroscopic balloon dilatation for anastomotic strictures in patients with esophageal atresia: A fifteen-year single centre UK experience.
abstract: OBJECTIVE
  To assess the safety and effectiveness of fluoroscopic balloon dilatation (FBD) in children with esophageal anastomotic stricture after surgical repair of esophageal atresia.
  
  
  METHODS
  All patients undergoing surgery for esophageal atresia and requiring dilatation(s) during a consecutive 15-year period [April 2000-September 2014] were analyzed. Dilatations were performed as day case procedures under general anesthesia using a radial force generating balloon device (Boston Scientific Corporation) by surgeons. Outcomes assessed included - (1) the number of dilatations/patient, (2) effectiveness and (3) need for surgery and (4) complications.
  
  
  RESULTS
  One hundred thirty seven patients underwent 625 FBD sessions (median 3 dilations per patient; range 1-24 dilatations). Median age at 1st FBD was 0.74years (range 0.05-16.1years). Balloon catheter sizes ranged from 6mm to 20mm. FBD yielded excellent results in 99 patients (74%), while 17 cases (13%) had mild ongoing dysphagia/dysmotility. Ten patients (7%) required further dilatation(s) to control symptoms. No patient(s) required esophageal stenting. Five cases required G-tube feeds as a result of oral aversion behavior - all of these cases were complex/VACTERL patients. Only 1 minor radiological leak occurred after a dilatation session and this did not require surgical intervention. A single patient (long gap EA TEF) with severe neurological impairment having multiple dilatations and stricture resection ultimately required esophageal replacement. Anti-reflux surgery was performed in 36 patients (26%) for medical therapy resistant GER.
  
  
  CONCLUSIONS
  FBD for anastomotic stricture(s) following esophageal atresia repair achieved very good outcomes for the majority of EA TEF patients. The procedure can be accomplished safely as indicated by the low complication rate herein reported. Although some children may require more than one dilatation session prompt relief of symptoms can be achieved with a vigilant care program co-ordinated by a multidisciplinary specialist EA TEF team.
authors.affiliation: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
authors.forename: Arimatias
authors.initials: A
authors.lastname: Raitio
authors.affiliation: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
authors.forename: Rosie
authors.initials: R
authors.lastname: Cresner
authors.affiliation: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Smith
authors.affiliation: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Jones
authors.affiliation: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; Academic Paediatric Surgery Unit, Institute of Child Health, University of Liverpool, UK. Electronic address: paul.losty@liverpool.ac.uk.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Losty
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D004106:Dilatation / Q000295:instrumentation / Q000379:methods*; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004944:Esophagoplasty; D004947:Esophagus / Q000601:surgery; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Balloon dilatation; Esophageal atresia; Flexible endoscopy; Outcome metrica; Stricture