Pediatric esophageal strictures: Outcomes of balloon dilatation over a 20-year period in a single-center cohort

A Toumi¹, M Messaoud¹, S Belhassen¹, S Laribi¹, S Mani¹, M Ben Fredj¹, S Ben Youssef¹, A Ksia¹, M Mekki¹, S Chakroun², M Ben Mansour², M Belghith¹, L Sahnoun²

¹Pediatric surgery department, Fattouma Bourguiba Hospital.
²Pediatric anaesthesia and intensive care department, Fattouma Bourguiba Hospital, Monastir, Tunisia

Background:
Benign esophageal strictures are the most common cause of esophageal narrowing in children. While various treatment modalities exist, endoscopic balloon dilation remains the standard of care.

Materials and Methods:
A retrospective descriptive study was conducted in the Department of Pediatric Surgery at Fattouma Bourguiba University Hospital, Monastir, Tunisia, over a 20-year period. All cases of esophageal strictures managed with endoscopic pneumatic dilation were included. Both short- and long-term outcomes were assessed.

Results:
A total of 343 children were included (54.5% male). The leading etiology was caustic ingestion (42%), followed by anastomotic strictures post-esophageal atresia repair (25.4%), peptic strictures (13.7%), achalasia (11.1%), congenital stenosis (5.8%), epidermolysis bullosa (6 cases), and one case of eosinophilic esophagitis. Over half (53.1%) of the patients were under 3 years of age, with a median age of 36 months [15.6–62.6]; age ranged from 9 to 213 months.

Most patients (69%) had a Z-score of 0, indicating average anthropometric status. Stricture length was <2 cm in 49.9% and >5 cm in 15.5%. A single stricture was present in 81.6% of cases. pPatients underwent a mean of 4.2 dilation sessions (range: 1–32).

Esophageal perforation occurred in 9.6%, typically after a median of 2 sessions [1–5]. Most perforations were pinpoint (54.5%), while 36.4% were large and 3 cases involved false passage due to guidewire misplacement. Management was conservative in most cases, with only 3 requiring surgical intervention. Mean hospital stay was 5 days [3–10], ranging from 2 to 52 days.

The overall success rate was 96.3%. The median duration of the dilation program was 10 months [5–27], regardless of etiology. Stenting was required in 5.8% (20 cases), and esophageal replacement was necessary in 5.2% (18 cases).

Conclusion:
Endoscopic balloon dilation is a highly effective and generally safe treatment for pediatric esophageal strictures, with a low rate of serious complications. With over 340 patients included, this study represents one of the largest pediatric series to date, reinforcing the reliability of balloon dilation as a first-line therapy

Keywords: esophageal strictures, endoscopic, balloon dilation, esophageal perforation

A Toumi¹, M Messaoud¹, S Belhassen¹, S Laribi¹, S Mani¹, M Ben Fredj¹, S Ben Youssef¹, A Ksia¹, M Mekki¹, S Chakroun², M Ben Mansour², M Belghith¹, L Sahnoun²

¹Pediatric surgery department, Fattouma Bourguiba Hospital.
²Pediatric anaesthesia and intensive care department, Fattouma Bourguiba Hospital, Monastir, Tunisia

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