Causes of pediatric esophageal strictures are different from adults and most strictures are amenable to endoscopic dilatation.

Methods: We analysed data of 34 consecutive pediatric patients with a diagnosis of esophageal stricture referred to our center between May 2002 and August 2005. Dilatations were performed initially once every week till a maximum dilatation of 15 mm and 12.8 mm could be achieved in children> 5 years and <5 years respectively. Secondary interventions were undertaken on recurrence of symptoms. All dilatations were done using Saving Guillard bougie dilators. Response to dilatation was classified as complete (clinical & radiological), partial (only clinical) and no response.

Results: Of the 34 cases, corrosive ingestion was the most frequent etiologic factor (16; 47%). The other etiologic factors were tracheo-esophageal fistula correction surgery (11.8%), associated with gastroesophageal reflux (8.8%), post endoscopic sclerotherapy (5.8%) and congenital syndromes (8.8%). In 17.6% (6/34) cases etiologic factor could not be determined. Median age at the time of presentation was 46 months (95% CI: 36-48). Children with corrosive ingestion (36 months) and unknown etiology (32.5 months) were much younger at presentation as compared to rest of the patients. Dysphagia (27/34; 79.4%) and vomiting (14/31; 45.2%) were the most frequent symptoms. Patients of corrosive ingestion presented sooner (median: 2 months; 95% CI:1-16.9) as compared to patients in other categories (median: 12 months; 95% CI: 037.9) (FETO.001). Intervention could be analysed in 23 patients; remaining were lost to follow up. A total of 184 sessions of dilatation were performed in these patients as initial intervention with a mean (+ S.D.) of 11.4 (+ 9.5) sessions per patient. Recurrence occurred in 8 (34.8%) patients requiring 68 cumulative sessions of dilatation. No mortality or major complications due to endoscopic dilatation occurred. Minor complications (hematemesis, desaturation and ulceration) occurred in 12/252 (4.8%) sessions. Response was complete in 60.9% (14/23; partial in 21.7% (5/23) and failed in 17.4% (4/23) who were referred for surgery.

Conclusion: Corrosive injury is the major cause of esophageal strictures respond to endoscopic treatment.

Pedgastro 2005 - Conference Abstracts.Pediatric Oncall [serial online] 2006 [cited 15 March 2006(Supplement 3)];3. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
esophageal_strictures.asp