Pediatric esophageal strictures often require repeated balloon dilatation (BD). Several studies have reported that steroids reduce fibrosis, but data on short-term intravenous steroid pulse therapy (ISPT) in children are limited. This study evaluated the effectiveness of BD combined with short-term ISPT for congenital esophageal stenosis (CES) and postoperative esophageal anastomotic stricture (AS) in pediatric patients. We retrospectively reviewed 21 pediatric patients treated with BD and ISPT from 2014 to 2020. The cohort included 10 patients with CES and 16 with AS; five patients had both at different anatomical sites. Methylprednisolone was administered intravenously at 20 mg/kg/day for 2 days, followed by 10 mg/kg/day for 2 more days, starting on the day of BD. BD was performed under general anesthesia at monthly intervals until stricture resolution. The primary endpoint was symptom-free status for ≥6 months following the final BD. Herein, 89 BD sessions were performed (1–7 per patient), with a median of three in both the CES and AS groups. All patients with CES and most with AS achieved long-term symptom relief over 49–123 months of follow-up. Four patients with AS experienced late recurrence (>12 months), all associated with gastroesophageal reflux disease. Five perforations occurred (CES treatment: three; AS treatment: two), all managed conservatively. No steroid-related adverse events were observed. BD combined with short-term ISPT is safe and effective for pediatric CES and AS, reducing restenosis risk and the need for repeated dilatations. This approach may improve long-term outcomes and reduce the need for surgery.
Okamoto et al. (Sun,) studied this question.