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Approach and Safety of Esophageal Dilation for Treatment of Strictures in Children With Epidermolysis Bullosa

Anderson, Bradley T.*; Feinstein, James A.*,†; Kramer, Robert E.*,‡; Narkewicz, Michael R.*,‡; Bruckner, Anna L.*,§; Brumbaugh, David E.*,‡

Journal of Pediatric Gastroenterology and Nutrition: December 2018 - Volume 67 - Issue 6 - p 701–705
doi: 10.1097/MPG.0000000000002106
Original Articles: Gastroenterology

Objective: The aim of the study is to analyze a large series of esophageal balloon dilations in patients with epidermolysis bullosa (EB) to determine procedural approach and frequency of post-endoscopic adverse events (AEs).

Methods: Retrospective chart review for AE occurrence and clinical outcomes in children and adolescents with EB, age 1 to 19, who underwent esophageal dilation for esophageal stricture(s) from January 2003 to April 2016 at an academic, tertiary care, free-standing children's hospital. The primary outcome measure was occurrence of procedural AEs (defined as events occurring within 72 hours after endoscopic dilation procedure).

Results: A total of 231 fluoroscopy-guided esophageal balloon dilation procedures (209 anterograde, 20 retrograde, 2 both) were performed in 24 patients. Strictures were more common in the proximal portion of the esophagus with median stricture location 13 cm from the lips. From 2003 to 2012, 4.1% of dilations were retrograde. From 2013 to 2016, 20.2% of dilations were retrograde. AEs attributable to dilation occurred after 10.0% of procedures, and the most common AEs were vomiting, pain, and fever. No esophageal perforations, serious bleeding events, or deaths occurred secondary to dilation. The rate of post-dilation hospitalization was 6.9%. Dilation approach (anterograde vs retrograde) did not impact the likelihood of AEs.

Conclusions: The characteristic esophageal lesion in EB is a single, proximal esophageal stricture. EB patients can safely undergo repeat pneumatic esophageal balloon dilations with minimal risk for severe complication. We observed a trend towards increased use of retrograde esophageal dilation.

*Department of Pediatrics

Section of General Pediatrics

Digestive Health Institute, Children's Hospital Colorado and the Section of Pediatric Gastroenterology, Hepatology and Nutrition

§Department of Dermatology, University of Colorado School of Medicine, Aurora, CO.

Address correspondence and reprint requests to David E. Brumbaugh, MD, Children's Hospital Colorado, 13123 E 16th Ave, B290, Aurora, CO 80045 (e-mail:

Received 6 November, 2017

Accepted 23 June, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

J.A.F. is supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (1K23HD091295-01).

The authors report no conflicts of interest.

© 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,