Skip to main content
SpringerLink
Log in

Developing balloon dilatation sizing guidance for anastomotic stricture dilatation following oesophageal atresia repair

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

To develop guidance for the selection of balloon catheter size when performing an oesophageal dilatation for a stricture post oesophageal atresia repair.

Methods

This was a single centre retrospective study at a paediatric tertiary centre. Dilatations were performed between 2015 and 2020. All dilatations were performed under general anaesthesia using balloon catheters under fluoroscopic guidance. Outliers were excluded using ROUT method and descriptive analysis was calculated to 1SD or IQR depending on the normality of data distribution.

Results

97 patients underwent 341 dilatations. Median age was 19 months (37 weeks corrected gestation—17 years), median weight was 10.7 kg (2.6–72 kg). Balloon catheter sizes ranged from 6–8 mm to 18–20 mm. There was strong correlation between weight and balloon size (r = 0.8, p < 0.0001). There were 2 perforations (0.6%), both diagnosed intra-operatively and treated conservatively. From the results, weight recommendations were created for each balloon size.

Conclusion

Fluoroscopic balloon dilatation is a safe and effective method to treat anastomotic stricture following oesophageal atresia repair. Previous studies have shown correlation between patient weight and oesophageal diameter. We propose guidance for using an appropriate balloon size based on patient’s weight with the aim to reduce complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Allin B, Knight M, Johnson P, Burge D (2014) Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia. PLoS ONE 9:e106149. https://doi.org/10.1371/journal.pone.0106149

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Laberge J, Lévesque D, Baird R (2013) Anastomotic stricture after esophageal atresia repair: a critical review of recent literature. Eur J Pediatr Surg 23(03):204–213. https://doi.org/10.1055/s-0033-1347917

    Article  PubMed  Google Scholar 

  3. Ijsselstijn H, van Beelen NW, Wijnen RM (2013) Esophageal atresia: long-term morbidities in adolescence and adulthood. Dis Esophagu, s 26:417–421. https://doi.org/10.1111/dote.12059

    Article  CAS  Google Scholar 

  4. Tambucci R, Angelino G, De Angelis P, Torroni F, Caldaro T, Balassone V et al (2017) Anastomotic strictures after esophageal atresia repair: incidence, investigations, and management, including treatment of refractory and recurrent strictures. Front Pediatr 29(5):120. https://doi.org/10.3389/fped.2017.00120

    Article  Google Scholar 

  5. Krishnan U, Mousa H, Dall’Oglio L, Homaira N, Rosen R, Faure C et al (2016) ESPGHAN-NASPGHAN Guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with esophageal atresia-tracheoesophageal fistula. J Pediatr Gastroenterol Nutr 63:550–570. https://doi.org/10.1097/MPG.0000000000001401

    Article  PubMed  Google Scholar 

  6. Haight C, Towsley HA (1943) Congenital atresia of the esophagus with tracheoesophageal fistula: extrapleural ligation of fistula and end-to-end anastomosis of esophageal segments. Surg Gynecol Obstet 76:672–688

    Google Scholar 

  7. Langston HT (1984) The first successful total repair of congenital atresia of the esophagus with tracheoesophageal fistula. Ann Thorac Surg 38(1):72–74. https://doi.org/10.1016/S0003-4975(10)62193-5

    Article  CAS  PubMed  Google Scholar 

  8. Ball WS, Strife JL, Rosenkrantz J et al (1984) Esophageal strictures in children: treatment by balloon dilatation. Radiology 150:263–264. https://doi.org/10.1148/radiology.150.1.6689772

    Article  CAS  PubMed  Google Scholar 

  9. Goldthorn JF, Ball WS Jr, Wilkinson LG et al (1984) Esophageal strictures in children: treatment by serial balloon catheter dilatation. Radiology 153:655–658. https://doi.org/10.1148/radiology.153.3.6238347

    Article  CAS  PubMed  Google Scholar 

  10. Thyoka M, Timmis A, Mhango T, Roebuck DJ (2013) Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia: a systematic review. Pediatr Radiol 43(08):898–901. https://doi.org/10.1007/s00247-013-2693-2

    Article  PubMed  Google Scholar 

  11. Lang T, Hummer HP, Behrens R (2001) Balloon dilatation is preferable to bougienage in children with esophageal atresia. Endoscopy 33(04):329–335. https://doi.org/10.1055/s-2001-13691

    Article  CAS  PubMed  Google Scholar 

  12. Lan LC, Wong KK, Lin SC et al (2003) Endoscopic balloon dilatation of esophageal strictures in infants and children: 17 years’ experience and a literature review. J Pediatr Surg 38(12):1712–1715. https://doi.org/10.1016/j.jpedsurg.2003.08.040

    Article  CAS  PubMed  Google Scholar 

  13. Bott TS, von Kalle T, Schilling A, Diez OH, Besch S, Mehlig U, Hetjens S, Wessel L, Loff S (2019) Esophageal diameters in children correlated to body weight. Eur J Pediatr Surg 29(06):528–532. https://doi.org/10.1055/s-0038-1675776

    Article  PubMed  Google Scholar 

  14. Motulsky HJ, Brown RE (2006) Detecting outliers when fitting data with nonlinear regression—a new method based on robust nonlinear regression and the false discovery rate. BMC Bioinform 7(1):1–20. https://doi.org/10.1186/1471-2105-7-123

    Article  CAS  Google Scholar 

  15. Tests for normality and descriptive statistics were performed using GraphPad Prism version 8.0.0 for Windows, GraphPad Software, San Diego, California USA. www.graphpad.com

  16. Langdon DF (1997) The rule of three in esophageal dilation. Gastrointest Endosc 45:111. https://doi.org/10.1016/S0016-5107(97)70320-1

    Article  CAS  PubMed  Google Scholar 

  17. Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R et al (2017) Paediatric gastrointestinal endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 64:133–153. https://doi.org/10.1097/MPG.0000000000001408

    Article  PubMed  Google Scholar 

  18. Kochhar R, Poornachandra KS (2010) Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures. World J Gastroenterol 2:61–68. https://doi.org/10.4253/wjge.v2.i2.61

    Article  Google Scholar 

  19. Lilly JR, Bensard D (1989) Intralesional steroid injection in the management of esophageal stricture. J Pediatr Surg 24:1312. https://doi.org/10.1016/s0022-3468(89)80576-7

    Article  CAS  PubMed  Google Scholar 

  20. Michaud L, Gottrand F (2011) Anastomotic strictures: conservative treatment. J Pediatr Gastroenterol Nutr 52(Suppl 1):S18-19. https://doi.org/10.1097/MPG.0b013e3182105ad1

    Article  PubMed  Google Scholar 

  21. Kramer RE, Quiros JA (2010) Esophageal stents for severe strictures in young children: experience, benefits, and risks. Curr Gastroenterol Rep 12:203–210. https://doi.org/10.1007/s11894-010-0105-4

    Article  PubMed  Google Scholar 

  22. Lévesque D, Baird R, Laberge J (2013) Refractory strictures post-esophageal atresia repair: what are the alternatives? Dis Esophagus 26(4):382–387. https://doi.org/10.1111/dote.12047

    Article  PubMed  Google Scholar 

  23. Katayev A, Balciza C, Seccombe DW (2010) Establishing reference intervals for clinical laboratory test results: is there a better way? Am J Clin Pathol 133(2):180–186. https://doi.org/10.1309/AJCPN5BMTSF1CDYP

    Article  CAS  PubMed  Google Scholar 

  24. Koivusalo A, Pakarinen MP, Rintala RJ (2009) Anastomotic dilatation after repair of esophageal atresia with distal fistula. Comparison of results after routine versus selective dilatation. Dis Esophagus 22:190–194. https://doi.org/10.1111/j.1442-2050.2008.00902.x

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Paediatric Surgery, Alder Hey Children’s NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, UK

    Hamish Walker, Adeline Salim, Charlotte Smith & Fiona Murphy

Authors
  1. Hamish Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adeline Salim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charlotte Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fiona Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by HW, AS, CS and FM. The first draft of the manuscript was written by Hamish Walker and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hamish Walker.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Walker, H., Salim, A., Smith, C. et al. Developing balloon dilatation sizing guidance for anastomotic stricture dilatation following oesophageal atresia repair. Pediatr Surg Int 39, 252 (2023). https://doi.org/10.1007/s00383-023-05536-5

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00383-023-05536-5

Keywords

Search

Navigation