Efficacy of bougie versus balloon dilatation in children with benign esophageal stricture: a propensity score–matched retrospective cohort study

Background and AimsEndoscopic dilatation is the primary management of esophageal strictures in children. However, pediatric data on which of the 2 endoscopic techniques, bougie or balloon, is better and the effect of endoscopic dilatation on the growth in children are lacking. We evaluated whether bougie or balloon dilatation is superior in efficacy and safety for short esophageal strictures in children and the impact of endoscopic dilatation on their growth.MethodsWe performed endoscopic dilatation every 2 to 3 weeks using either a bougie or balloon and considered it adequate if we could dilate the esophageal lumen to 15 mm (11 mm in ages <2 years, 12 mm in ages 2-5 years) with complete relief of symptoms for >2 months.ResultsTwo hundred fifty-nine children were enrolled, with 2580 dilatations performed during the study. We performed a comparative analysis on 77 children where an exclusive bougie versus balloon dilatation was carried out for short strictures (defined as stricture length <5 cm). Both bougie and balloon dilatation showed similar efficacy (median number of sessions for adequate dilatation: 5 [interquartile range, 2.5-7.5] vs 4 [interquartile range, 2-6]; P = .40) and safety (perforation rate: .35% vs .54% P = .591) for short strictures. On a median follow-up of 17 months, there was a significant improvement in both weight and height z-scores in children with successful dilatation.ConclusionsEndoscopic bougie and balloon dilatations were safe and effective, with no significant difference for short strictures. Successful dilatation resulted in significant improvement in growth on follow-up. Endoscopic dilatation is the primary management of esophageal strictures in children. However, pediatric data on which of the 2 endoscopic techniques, bougie or balloon, is better and the effect of endoscopic dilatation on the growth in children are lacking. We evaluated whether bougie or balloon dilatation is superior in efficacy and safety for short esophageal strictures in children and the impact of endoscopic dilatation on their growth. We performed endoscopic dilatation every 2 to 3 weeks using either a bougie or balloon and considered it adequate if we could dilate the esophageal lumen to 15 mm (11 mm in ages <2 years, 12 mm in ages 2-5 years) with complete relief of symptoms for >2 months. Two hundred fifty-nine children were enrolled, with 2580 dilatations performed during the study. We performed a comparative analysis on 77 children where an exclusive bougie versus balloon dilatation was carried out for short strictures (defined as stricture length <5 cm). Both bougie and balloon dilatation showed similar efficacy (median number of sessions for adequate dilatation: 5 [interquartile range, 2.5-7.5] vs 4 [interquartile range, 2-6]; P = .40) and safety (perforation rate: .35% vs .54% P = .591) for short strictures. On a median follow-up of 17 months, there was a significant improvement in both weight and height z-scores in children with successful dilatation. Endoscopic bougie and balloon dilatations were safe and effective, with no significant difference for short strictures. Successful dilatation resulted in significant improvement in growth on follow-up.