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Pediatric Esophageal Dilatations: A Cross-Specialty Experience

Davidson, JR; McCluney, S; Reddy, K; Hadjichristou, N; Mutalib, M; Monzon, L; Yardley, IE; (2020) Pediatric Esophageal Dilatations: A Cross-Specialty Experience. Journal of Laparoendoscopic & Advanced Surgical Techniques , 30 (2) pp. 206-209. 10.1089/lap.2019.0592. Green open access

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Abstract

AIM OF THE STUDY: Esophageal dilatations are commonly performed in pediatric patients who have undergone an esophageal atresia/tracheoesophageal fistula (EA/TEF) repair or following caustic injury. We sought to compare the practice of esophageal dilatation across different specialties. METHODS: We analyzed all patients who had an esophageal dilatation at our center between April 2014 and December 2018. Patients were identified via prospectively maintained databases and clinical coding records. Patients had a combination of dilatations under each specialty: interventional radiology (IR), surgery, and gastroenterology. RESULTS: Thirty-five individual patients underwent 226 dilatations, median dilatations per patient was 3 (1–40). The median age at first dilatation was 18 months (1–194 months). Sixty-eight percent of patients had a previous EA/TEF repair. IR performed 59% of dilatations, surgeons 26%, and 15% by gastroenterologists. Surgeons more frequently were performing initial dilatations (P < .05) and performed more dilatations in EA/TEF patients (P < .0001). There was a significant difference between the time from a surgical dilatation until the next dilatation, 3.7 months, compared with an IR dilatation, 1.8 months (ANOVA, P < .05). Surgeons more frequently increased the size of balloon used (57% versus 33% versus 39%, P < .01). There was no significant difference in balloon size between specialties or in the incremental increase in size between subsequent dilatations. There was one postprocedure perforation, managed conservatively (complication rate = 0.4%). CONCLUSIONS: We have demonstrated that on average, patients wait longer after a surgical dilatation until their next procedure, and surgical teams are more likely to increase the size of the dilating balloon. Surgeons tend to be more involved in their postoperative patients in the initial phases of stricture management. Our results suggest the feasibility and safety of a multispecialty approach for these patients.

Type: Article
Title: Pediatric Esophageal Dilatations: A Cross-Specialty Experience
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1089/lap.2019.0592
Publisher version: https://doi.org/10.1089/lap.2019.0592
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisherís terms and conditions.
Keywords: TF, caustic, dilatation, esophageal atresia, esophageal dilatation, esophagus, tracheoesophageal fistula
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10093418
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