Benign esophageal strictures in children and adolescents: etiology, clinical profile, and results of endoscopic dilation

Background: The problem of dysphagia in children ado adolescents differs from that in adults, and therefore requires special consideration. Methods: Forty-one consecutive children and adolescents 16 years of age or younger (mean, 7.2 years), with benign esophageal strictures were evaluated in a prospective manner over a 7-year period. The most frequent causes of esophageal strictures were caustic ingestion and complications of endoscopic sclerotherapy of esophageal varices. Dilation was done on a weekly basis using bougies and was considered adequate if the esophageal lumen could be dilated to 15 mm diameter (11 mm in children less than 5 years old) with complete relief of dysphagia. Results: Of the 30 patients who could be adequately followed after initial dilation, 16 had corrosive strictures and 14 had strictures due to other causes. Patients with corrosive strictures required a significantly higher number of sessions for adequate initial dilation (7.8±2.5 sessions vs 1.86±0.48 sessions; p<0.01). Patients with corrosive strictures had a higher number of mean symptomatic recurrences per patient month as compared to the noncorrosive stricture group (0.15±0.01 vs 0.087±0.03, p<0.01). Six esophageal perforations occurred during a total of 327 dilation sessions (1.8%); there was one fatality. Conclusions: From our experience, we conclude that benign esophageal strictures in young patients can be treated effectively and with acceptable safety by means of endoscopic dilation.