ENDOSCOPIC WIRE GUIDED ESOPHAGEAL DILATATION IN CHILDREN WITH STRICTURE ESOPHAGUS: OUTCOME OF TREATMENT IN OUR SET UP

ABSTRACT
Objectives: To know the short-term outcome of endoscopic wire guided esophageal dilatation in children with stricture
esophagus
Study design: Retrospective and descriptive
Place and duration of study: The study was conducted at the department of pediatric surgery PGMI, Lady Reading
Hospital Peshawar from January 2014 to June 2016.
Material and methods: All the patients with stricture esophagus due to various causes, diagnosed by barium swallow
examination were admitted to pediatric surgery ward. Informed written consent was obtained from the parents of the
patients and they were counseled about the treatment and consequences of the procedure. The procedure was performed
under general anesthesia in all patients. Esophageal dilatation was performed with the flexible dilators passing
over the guide wire following its endoscopic insertion. Rigid esophagoscope of the required size with video-scope
monitor was used for guide wire insertion. Patients were observed in the ward and discharged to home 24 hours after
the procedure. They were asked to come to outpatient department every 2-4 weeks for 6 months or when needed.
Results: Thirty two children with stricture esophagus were assessed during the study period of 2.5 years. Age ranged
from 2 to 7 years with a mean age of 4 years. There were 20 males and 12 females. There were 15 patients with corrosive
stricture, 10 with peptic strictures, 4 with achalasia and 3 with stricture due to esophageal atresia repair. There
was no patient with stricture due to other causes such as congenital stenosis, eosinophilic esophagitis, epidermolysis
bullosa or neoplasia of esophagus. In 17 patients stricture was successfully dilated with in three sessions of esophageal
dilatation. Ten patients needed 3-5 times dilatation while 5 patients needed esophageal dilatation for more than 5 times.
There was no patient with stricture refractory to esophageal dilatation. In 1 patient a small esophageal perforation was
seen as a complication of the procedure which was treated conservatively. None of these patients needed other surgical
procedure such as stricture resection or esophageal replacement or gastric pull-up operation.
Conclusions: Endoscopic wire-guided esophageal dilatation is a safe and effective way of treatment for most esophageal
strictures in children. Corrosive strictures need more dilatation sessions than the other benign strictures and the
associated conditions should simultaneously be treated to preserve the outcome of stricture treatment. Esophageal
perforation is a serious complication of the procedure which may be prevented by taking precautions. Every effort
should be made to make the esophageal program successful ensuring better quality of life compared to surgery in
young children with high mortality and morbidity after surgical procedures in these patients. It is concluded that the
endoscopic wire-guided esophageal dilatation is the first line of treatment in benign strictures esophagus in children.
Key words: stricture esophagus, esophageal dilatation, esophagoscopy, guide wire, children