The joint European Society of Gastrointestinal Endoscopy and European Society of Paediatric Gastroenterology Hepatology and Nutrition guidelines on therapeutic indications of endoscopy recommend the use of esophagogastroduodenoscopy in the dilatation of oesophagus and upper gastrointestinal strictures and the use of ileocolonoscopy for dilatation of ileocolonic and colonic stenosis.¹

We conducted a retrospective observational study of gastrointestinal dilatations performed by Paediatric Gastroenterologists over a 10 yr period (1 January 2012 to 31 December 2022) in our centre. Prospective records of procedures were used to identify the patients and the electronic health records were reviewed.

163 endoscopic dilatations were performed in 52 patients during this period. The procedures were either performed or supervised by Gastroenterologist with an interest in therapeutic endoscopy. The age group of the patients ranged between 3 months to 17 yrs with a mean of 12.3 years. Anatomical sites dilated were as follows: 92 oesophageal, 7 pyloric/antral, 16 duodenal, 9 ileal, 2 colonic, 1 ileostomy, 3 rectal stumps and 32 rectal.

Hagar dilators with or without balloon dilatation were used in 15 of 32 rectal strictures. Through the scope balloon dilatation was used for all other strictures 130 of 163. In 40 procedures there were additional interventions performed alongside dilatation which included 2 endoknife cut, 1 argon laser and hemostatic clip application, 26 injection of Triamcinolone acetonide, 9 Mitomycin c spray and 4 injection of botulinum toxin.

Underlying aetiologies were recorded as follows: 34 congenital stricture/web, 46 Crohn’s disease, 11 anastomotic stricture, 1 radiotherapy-induced stricture, 41 strictures secondary to gastroesophageal reflux disease, and unknown aetiology in 7. Inflamed mucosa at the stricture site was noted in 63 procedures. 158 of these procedures were performed by the Gastroenterologist independently and 5 procedures were done jointly with a Paediatric Surgeon.

Children were discharged the same day for 124 procedures. The rest were done during an inpatient stay. Four procedures were associated with serious complications. Two had perforation requiring surgery and intensive care admission; both children were 2 yrs or younger. One patient became unwell with the intraabdominal collection but no perforation. One patient required 24 hrs of observations for persistent rectal bleeding but did not require further intervention. One patient was readmitted within 8 days of discharge.

In conclusion, endoscopic dilatation when performed by a gastroenterologist with therapeutic interest appears to be a safe alternative to surgical management of strictures. The risk of complications is small and the majority can be performed as a day case. Procedures in children under 2 yrs of age carry the most risk of bowel perforation.

Reference

1. Tringali A, Thomson M, et al. Pediatric gastrointestinal endoscopy: european society of gastro- intestinal endoscopy (ESGE) and European society for paediatric gastroenterology hepatology and nutrition (ESPGHAN) guideline executive summary. Endoscopy 2017;49:83–91.