Esophageal dilatation using Savary bougies. Experience in thirty-four children

Esophageal strictures in pediatric patients are rare and usually acquired, Improvements in flexible endoscopes and esophageal dilators have increased the efficacy and safety of instrumental esophageal dilatation. The cause and severity of the stricture are the main determinants of the efficacy of dilatation. One hundred fifteen dilatations done over a 56-month period in 34 children were reviewed retrospectively, Diagnoses were as follows: stricture at the site of anastomosis after surgery for esophageal atresia (n = 17), esophageal stricture or dyskinesia (decreased esophageal wall motility) after surgery for a gastroesophageal reflux (n = 12), stricture after surgery for achalasia (n = 2), stricture due to ingestion of corrosive compounds (n = 2), and stricture due to sclerosis of esophageal varices (n = 1). All dilatations were done endoscopically using Savary bougies, under general anesthesia. The two children with corrosive esophagitis had the largest number of dilatations, i.e., a total of 41. Most of the other patients had one to three dilatations. The outcome was favorable in the two patients who had had surgery for achalasia. In the remaining patients, the success rate was 83 %. Dilatation was successful in only one of the two patients with corrosive esophagitis. Two patients developed pneumothorax; one of these two died with bilateral pneumothorax due to perforation of the esophagus. Other adverse events consisted of minor bleeding of the esophageal mucosa (26 episodes), tracheal compression with transient cyanosis (2 episodes), and fever due to pneumonia (one episode). Endoscopic dilatation has superseded surgery for the first-line treatment of esophageal strictures in children. Surgery is now used mainly in patients who fail dilatation. Dilatation using Savary bougies is an effective conservative treatment for esophageal strictures in pediatric patients. However, adverse events are not infrequent and esophageal perforation with severe consequences can occur. Patients should be supervised in the hospital for 24 hours after each dilatation.