Acquired oesophageal strictures in children: emphasis on the use of string-guided dilatations

Saleem MM
Correspondence: Dr Mohammad M Saleem, mohomari@hotmail.com

ABSTRACT
Introduction Acquired oesophageal strictures are common in children. Treatment is either surgical or conservative by dilatations. String-guided dilators (SGD) are not well popularised. This is a report of the paediatric surgery experience at Jordan University Hospital on a group of 38 children, with emphasis on the use of SGD.
Methods Between January 1998 and January 2006, a total of 38 children (median age 3.2 years; range one month to ten years) with acquired oesophageal strictures were managed in the paediatric surgery unit. Main causes of strictures were corrosive strictures (18, 47.3 percent), post-oesophageal atresia repair (9, 23.6 percent) and post-hiatus hernia repair (4, 10.5 percent). SGD was used in 18 children, six following perforation and 12 classified as severe according to the established criteria. 14 were secondary to corrosive strictures.
Results There were 801 dilatation sessions with an average of 20.1 +/- 17.3 dilatation sessions per patient. Corrosive strictures were more severe, and required more dilatations per patient. The mean dilatation was 34.2 +/- 16.6 for corrosive strictures vs. 10.4 +/- 8.2 for non-corrosive strictures (p-value is less than 0.0001). 32 (84.2 percent) were successfully dilatated. Two are currently still under treatment and four failed conservative treatment after dilatation for one year. Two underwent oesophageal replacement and two refused surgery but continued to receive dilatation at 4–6 week intervals. SGD was used on 18 patients, six following perforation episodes. Two (5.3 percent) complications resulted in oesophageal perforations.
Conclusion Tucker’s dilators, with or without string, are safe, cost-effective and the use of string is a safeguard against perforations.

Keywords: acquired stricture, corrosive stricture, oesophageal stricture, string-guided dilator
Singapore Med J 2009; 50(1): 82-86