Esophageal stenosis in epidermolysis bullosum: a challenge for the endoscopist

J Pediatr Surg. 2011 May;46(5):842-7. doi: 10.1016/j.jpedsurg.2011.02.017.

Abstract

Background/purpose: Esophageal stenosis is a severe complication in dystrophic epidermolysis bullosa (EB). Endoscopic dilations may cause mucosal injury with stricture recurrence. Our aim was to describe our referral EB-center experience on safety and long-term efficacy of fluoroscopically guided balloon dilation without endoscopy.

Methods: Over 14 years, 34 patients with EB, previously evaluated with barium esophagogram for dysphagia, underwent balloon esophageal dilation. Under fluoroscopy, a guide wire was introduced via a nostril into the stomach. A 12-mm pneumatic balloon, which passed over the wire, was filled using radio-opaque contrast, dilating the stricture. Orotracheal intubation was avoided. Antibiotics, dexamethasone, and proton-pump inhibitors were administered. Study approval was obtained from our ethical board.

Results: Ninety-three dilations were performed. Seventeen patients had a single stenosis. The mean age of onset was 18 years (range, 3-47 years). Thirteen patients underwent one dilation. In 6 cases, endoscopy was necessary to visualize the esophageal lumen. Complications included cervical esophageal perforation (2) and transitory dysphagia (10). Thirty patients were feeding within 24 hours. During the follow-up, 2 patients required a gastrostomy, and 2 patients underwent fundoplication for gastroesophageal reflux disease.

Conclusions: Fluoroscopically guided balloon dilation in EB is a safe and well-tolerated procedure. An experienced endoscopy team is necessary in certain cases.

MeSH terms

  • Adolescent
  • Adult
  • Antibiotic Prophylaxis
  • Catheterization / adverse effects
  • Catheterization / methods*
  • Cefoxitin / administration & dosage
  • Cefoxitin / therapeutic use
  • Child
  • Child, Preschool
  • Contraindications
  • Deglutition Disorders / etiology
  • Dexamethasone / administration & dosage
  • Dexamethasone / therapeutic use
  • Epidermolysis Bullosa / complications*
  • Esophageal Perforation / etiology
  • Esophageal Stenosis / etiology
  • Esophageal Stenosis / surgery
  • Esophageal Stenosis / therapy*
  • Esophagoscopy*
  • Female
  • Fluoroscopy
  • Gastrostomy
  • Humans
  • Male
  • Middle Aged
  • Preanesthetic Medication
  • Proton Pump Inhibitors / administration & dosage
  • Proton Pump Inhibitors / therapeutic use
  • Radiography, Interventional
  • Young Adult

Substances

  • Proton Pump Inhibitors
  • Cefoxitin
  • Dexamethasone