WOFAPS 2025 8th World Congress of Pediatric Surgery

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Poster - 8

Pediatric esophageal strictures: Outcomes of balloon dilatation over a 20-year period in a single-center cohort

Afef Toumi 1, Marwa Messaoud 1, Samia Belhassen 1, Syrine Laribi 1, Salma Mani 1, Myriam Ben Fredj 1, Sabrine Ben Youssef 1, Amine Ksia 1, Mongi Mekki 1, Sawsen Chakroun 2, Maha Ben Mansour 2, Mohsen Belghith 1, Lassaad Sahnoun 2
1 Pediatric surgery department, Fattouma Bourguiba Hospital.
2 Pediatric anaesthesia and intensive care department, Fattouma Bourguiba Hospital, Monastir, Tunisia

Background:
Benign esophageal strictures are the most common cause of esophageal narrowing in children. While various treatment modalities exist, endoscopic balloon dilation remains the standard of care.

Materials and Methods:
A retrospective descriptive study was conducted in the Department of Pediatric Surgery at Fattouma Bourguiba University Hospital, Monastir, Tunisia, over a 20-year period. All cases of esophageal strictures managed with endoscopic pneumatic dilation were included. Both short- and long-term outcomes were assessed.

Results:
A total of 343 children were included (54.5% male). The leading etiology was caustic ingestion (42%), followed by anastomotic strictures post-esophageal atresia repair (25.4%), peptic strictures (13.7%), achalasia (11.1%), congenital stenosis (5.8%), epidermolysis bullosa (6 cases), and one case of eosinophilic esophagitis. Over half (53.1%) of the patients were under 3 years of age, with a median age of 36 months [15.6–62.6]; age ranged from 9 to 213 months.

Most patients (69%) had a Z-score of 0, indicating average anthropometric status. Stricture length was <2 cm in 49.9% and >5 cm in 15.5%. A single stricture was present in 81.6% of cases. pPatients underwent a mean of 4.2 dilation sessions (range: 1–32).

Esophageal perforation occurred in 9.6%, typically after a median of 2 sessions [1–5]. Most perforations were pinpoint (54.5%), while 36.4% were large and 3 cases involved false passage due to guidewire misplacement. Management was conservative in most cases, with only 3 requiring surgical intervention. Mean hospital stay was 5 days [3–10], ranging from 2 to 52 days.

The overall success rate was 96.3%. The median duration of the dilation program was 10 months [5–27], regardless of etiology. Stenting was required in 5.8% (20 cases), and esophageal replacement was necessary in 5.2% (18 cases).

Conclusion:
Endoscopic balloon dilation is a highly effective and generally safe treatment for pediatric esophageal strictures, with a low rate of serious complications. With over 340 patients included, this study represents one of the largest pediatric series to date, reinforcing the reliability of balloon dilation as a first-line therapy

Keywords: esophageal strictures, endoscopic, balloon dilation, esophageal perforation

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