Fluoroscopic Guided Esophageal Stricture Balloon Dilatation Outcomes: Epidermolysis Bullosa Pediatric Specialty Center

Tuesday, April 1, 2025

3:36 PM – 3:45 PM CT

Location: Music City Center, 207 CD

Presenting Author(s)

Sajel Dutt (she/her/hers)

Medical Student
University of Minnesota, United States

Author/Co-author(s)

AP

Andrew Peterson, MD

Integrated IR Resident
University of Minnesota, United States
Siobhan Flanagan, MD

Associate Professor
University of Minnesota, United States
Reza Talaie, MD

Associate Professor
University of Minnesota, United States
PS

Prashant Shrestha, MD

Assistant Professor
University of Minnesota, United States

Purpose: Evaluate technical and clinical outcomes of esophageal stricture balloon dilation (ESBD) predominantly related to epidermolysis bullosa (EB), with a smaller cohort related to tracheo-esophageal fistula (TEF).

Materials and Methods: Retrospective single center review of subjects who underwent fluoroscopic guided ESBD. 38 unique subjects (21 male and 17 female) underwent a total of 155 dilatation events. 33 (87%) and 5 (13%) subjects suffered EB and TEF related strictures, respectively. Technical success was defined as resolution of the stricture without recoil and clinical success as increasing time interval between dilatation events, less than 4 dilatations per year, or no dilatation for greater than 1 year.

Results: Technical success was achieved in all but 1 dilatation event. The mean number of dilations per subject was 4 (SD 4.6, range 1-20), mean balloon diameter 10.4 mm (SD 1.9, range 6-14), and the mean time interval between dilations was 286 days (SD 258, range 17-1106). SIR grade mild adverse events occurred in 10 (26%) subjects, including self limiting dysphagia and emesis. 32 subjects (89%) met criteria for clinical success. Subjects achieving clinical success demonstrated longer time interval between dilations (329 vs. 94 days, p=0.002), higher initial weight percentile (16 vs 4, p=0.034), and higher height percentile at the final dilation (24 vs 11, p=0.048). When comparing EB vs TEF related subjects, TEF patients were much younger at first treatment (0.5 vs. 8.5 years old, p=0.01) and required less mean dilation sessions per subject (2 vs 4.4, p=0.027). However, there was no significant difference in clinical success between EB and TEF patients. The location of the stricture within the esophagus did not impact rates of clinical success or adverse events.

Conclusion: Fluoroscopic guided ESBD is a safe and effective minimally invasive treatment for esophageal strictures related to EB and TEF. Most adverse events are mild and self limiting. EB strictures appear to require more frequent dilations than TEF strictures.