Post written by Ujjal Poddar, MD, DNB, DM, from the Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

We conducted this propensity score—matched retrospective study to compare bougie versus balloon dilatation for short esophageal strictures in children and assess the outcome of endoscopic dilatation on their growth.

Although uncommon, esophageal strictures are challenging to treat in children. A few studies have demonstrated good efficacy and safety of endoscopic bougie and balloon dilatation in the management of esophageal strictures in children.

However, none of the studies compared bougie versus balloon dilatation in the same period in children. Determining which of the 2 dilatation techniques is superior will result in better application of these devices in day-to-day practice. Furthermore, there is a paucity of data on the impact of endoscopic dilatation on the growth of these affected children.

Using propensity score—matched multivariate analysis, we showed that bougie (n = 20) and balloon (n = 23) dilators have comparable efficacy (median number of sessions for adequate dilatation: 5 [interquartile range, 2.5-7.5] vs 4 [interquartile range, 2-6]; P = .40) and safety (perforation rate: .35% vs .54%; P = .591) for short strictures in children.

Over a median follow-up of 17 months, we clarified that we observed significant improvement in weight and height z-scores in children with successful dilatation for all etiologies, suggesting our age-related target dilatation was adequate for catch-up growth.

In addition, in the overall cohort (n = 259), we documented that endoscopic dilatation was successful in 90.32% (168 out of 186). Future studies in the form of randomized controlled trials with a larger sample size should follow for comparing bougie and balloon dilatation.

Three strong points of our study are:

• To the best of our knowledge, this is the first study comparing the efficacy and safety of bougie versus balloon dilatation in children. We recorded comparable efficacy and safety of the methods, giving liberty to the endoscopist to choose either for short esophageal strictures based on his or her expertise until the availability of further evidence.
• This is the first study to document the effect of endoscopic bougie and balloon dilatation on growth (using weight and height z-scores) in children.
• We presented excellent success (90%) with endoscopic dilatation in one of the largest cohorts with a diverse etiology over a longer study duration, reiterating that endoscopic dilatation should be the primary treatment modality for managing esophageal strictures in children.

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