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TÜRKÇE
Poster - 15
Timing Matters : Impact of delay to first balloon dilation on outcomes of pediatric caustic esophageal strictures
Messaoud Marwa 1, Afef Toumi 1, Samia Belhassen 1, Syrine Laribi 1, Myriam Ben Fredj 1, Sabrine Ben Youssef 1, Sami Sfar 1, Amine Ksia 1, Mongi Mekki 1, Sawsen Chakroun 2, Maha Ben Mansour 2, Mohsen Belghith 1, Lassaad Sahnoun 1
1 Pediatric surgery department, Fattouma Bourguiba Hospital.
2 Pediatric anaesthesia and intensive care department, Fattouma Bourguiba Hospital, Monastir, Tunisia
Background:
Caustic esophageal strictures are a serious complication in children after corrosive ingestion. Endoscopic balloon dilation is the standard treatment, but the optimal timing for the first dilation remains unclear.
Objective:
To evaluate whether the interval between ingestion and first dilation affects the risk of dilation failure and esophageal perforation.
Methods:
A retrospective study of pediatric patients treated for caustic esophageal strictures from 2004 to 2024 was conducted. Data included demographics, stricture characteristics, timing of first dilation, and outcomes (failure, perforation). Patients were grouped by time intervals (≤30 vs. >30 days; ≤60 vs. >60 days). Outcomes were analyzed using Kaplan-Meier curves and Cox regression (p < 0.05).
Results:
Delayed dilation (>30 and >60 days) was associated with significantly longer event-free survival for both failure and perforation. Patients dilated after 60 days showed a mean time to failure of 1416 days versus 30 days for earlier dilation (p < 0.001), and mean time to perforation of 1167 versus 30 days (p < 0.001). Cox regression confirmed that each additional day of delay reduced the risk of failure (HR=0.995, 95% CI [0.990–1.000], p=0.040). Age, weight, and number of strictures were not significant predictors. Early dilation was linked to earlier perforation occurrence (mean 30 vs. 1167 days, p < 0.001).
Conclusion:
Delaying the first balloon dilation beyond 30 days post-ingestion reduces the risk of treatment failure and perforation, likely by avoiding the fragile inflammatory phase, supporting a delayed, individualized approach in managing pediatric caustic esophageal strictures.