Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia

The purpose of this study was to evaluate the efficiency and safety of oesophageal balloon dilatation in strictures secondary to surgical treatment of oesophageal atresia in 25 children. Patients comprised 15 males and 10 females, aged 1-36 months. Median age was 4 months (interquartile range (IQR)519). The strictures were more than 50% of oesophageal lumen and the delay from surgical treatment to balloon dilatation varied from 1 month to 36 months. Associated gastroesophageal reflux was noted in 15 patients. All procedures were performed under sedation using fluoroscopic guidance. Balloons of increasing diameter, 4-20 mm were used. Water soluble contrast swallow was performed after each dilatation session. A total of 115 balloon dilatation sessions were performed with a range of 1-14 procedures per patient (median 4 dilatations, IQR54.5). Dilatation relieved the stricture in all patients over a follow-up period varying from 4 months to 33 months. The best results were noted in children under 6 months, who needed two or few dilatation sessions, with relative risk (RR) of 0.52 and 95% confidence interval of 0.29-0.92. The presence of associated gastroesophageal reflux indicated a high risk (RR of 12, p,0.001) for undergoing more than two balloon dilatation sessions. The only serious complications observed were two cases of oesophageal perforation, which were treated conservatively. Fluoroscopically guided balloon dilatation is a safe and effective treatment in the management of strictures secondary to surgical repair of oesophageal atresia, especially when started early (within 6 months of surgery) and not associated with gastroesophageal reflux. Oesophageal atresia (OA), with or without tracheoesoph- ageal fistula, is the most common congenital malforma- tion of the oesophagus. It requires primary or delayed surgical anastomosis. Mortality after primary repair of OA is almost negligible when there are no associated severe cardiac, cerebral or pulmonary problems. Post-operative morbidity depends on the incidence of leakage, gastro- esophageal reflux (GOR) and strictures. Anastomotic stric- ture occurs in 18-50% of patients undergoing repair of OA (1, 2). Treatment of choice for symptomatic oesophageal strictures is dilatation. This is traditionally performed using rigid dilators in an antegrade manner or retrograde dila- tation through a gastrostomy site. This procedure often causes significant injury to the mucosa and therefore leads to scars and further stricture. During the last two decades, balloon dilatation (BD) has become more frequently used (3-5). This report details our experience using balloon dilatation to treat 25 children with anastomotic stricture following surgical repair of OA.