Lang T, Hümmer H P, Behrens R
Dept. of Pediatric Gastroenterology, Children's Hospital, University of Erlangen, Germany.
Endoscopy. 2001 Apr;33(4):329-35. doi: 10.1055/s-2001-13691.
Esophageal strictures are a common problem after surgical repair in children with esophageal atresia. The traditional procedure in these patients is dilation using bougie dilators, usually controlled fluoroscopically or endoscopically. Nowadays, an alternative technique is balloon-catheter dilation. The aim of this study was to report our experience with pneumatic balloon dilation and to compare this method with previously performed bougienage with regard to efficacy.
Over 16 years, 34 patients who developed symptomatic strictures were encountered at our institution. In the first 9 years 12 patients underwent 178 bougienages (group C). In the last 7 years six patients who had undergone 202 previous bougienages (group B), and 16 patients who had undergone no bougienages (group A), underwent 52 dilations. The dilation was carried out under intravenous sedation using a combination of midazolam and etomidate. The balloon was placed in the stricture endoscopically and the procedure was performed under fluoroscopic and endoscopic control.
In all patients the dilation was effective and involved minimal trauma. The strictures required 1 to 7 procedures (median 2) over a maximum of 18 months (median 3 months) for a good treatment result. The complications observed were two perforations, one of them with pneumothorax (both treated conservatively), and two compressions of the trachea (interruption of the procedure, but efficient dilation was eventually achieved). The method was more effective than bougienage (1 to 60 bougienages were required per patient, median 9).
Compared with traditional bougienage, balloon dilation of esophageal strictures is less traumatic and more effective. Complications are rare and can be managed conservatively. In our opinion this procedure is the appropriate treatment for strictures, even in very small infants, after repair of esophageal atresia.
食管闭锁患儿手术修复后食管狭窄是常见问题。这些患者的传统治疗方法是使用探条扩张器进行扩张，通常在荧光镜或内镜控制下操作。如今，一种替代技术是球囊导管扩张。本研究的目的是报告我们使用气动球囊扩张的经验，并在疗效方面将该方法与先前进行的探条扩张术进行比较。
在16年期间，我们机构共遇到34例出现症状性狭窄的患者。前9年，12例患者接受了178次探条扩张术（C组）。后7年，6例此前已接受过202次探条扩张术的患者（B组）以及16例未接受过探条扩张术的患者（A组）接受了52次扩张。扩张在静脉镇静下进行，使用咪达唑仑和依托咪酯联合用药。球囊通过内镜放置在狭窄部位，操作在荧光镜和内镜控制下进行。
所有患者的扩张均有效且创伤极小。狭窄需要在最长18个月（中位数3个月）内进行1至7次操作（中位数2次）以获得良好治疗效果。观察到的并发症有2例穿孔，其中1例伴有气胸（均保守治疗），以及2例气管受压（操作中断，但最终实现了有效扩张）。该方法比探条扩张术更有效（每位患者需要1至60次探条扩张术，中位数为9次）。
与传统探条扩张术相比，食管狭窄的球囊扩张创伤更小且更有效。并发症罕见且可保守处理。我们认为，即使对于非常小的婴儿，该方法也是食管闭锁修复术后狭窄的合适治疗方法。
