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Comparative Analysis of Adverse Events After Esophageal Balloon and Bougie Dilations in Children

Mark, Jacob A.*; Anderson, Bradley T.*,†; Pan, Zhaoxing; Menard-Katcher, Calies*; Kramer, Robert E.*

Journal of Pediatric Gastroenterology and Nutrition: May 2019 - Volume 68 - Issue 5 - p 630–634
doi: 10.1097/MPG.0000000000002237
Original Articles: Gastroenterology

Background: Pneumatic balloon and bougie dilation are widely used methods for pediatric esophageal dilation. There are no studies directly comparing the safety of these techniques in pediatric patients. This study compared adverse events (AEs) of balloon and bougie dilation in children at a single institution.

Methods: AEs were identified by means of a prospective clinical registry of all procedure related AEs from 2012 to 2015 at a single institution. Identified AEs underwent retrospective review of procedural and clinical details. The category of each AE was recorded and severity was assigned using a 5-point scoring system. AEs were compared between balloon and bougie dilation for different severities.

Results: There were 105 patients who underwent 246 dilation sessions. Balloon dilation was performed more commonly (n = 190, 77%) as compared to Maloney dilators (n = 56, 23%). Patients with balloon dilation were younger (3.0 vs 14.5 years, P = 0.0001) and more likely to have strictures from caustic ingestion (42% vs 2%, P < 0.0001) or surgical anastomoses (34% vs 5% P < 0.0001). Bougie dilation was used more commonly in patients with eosinophilic esophagitis (77% vs 7%, P < 0.0001)). In multivariate analysis, each year of increasing age was associated with a 12% increase in any AEs (P = 0.015), but no difference in clinically significant AEs (grade 2 or higher) was identified between dilation methods.

Conclusions: Bougie and balloon dilation did not have significant differences in AE rates, but the patient populations differed between the 2 methods. The dilation method should depend on stricture characteristics and endoscopist expertise with each method.

*Section of Gastroenterology, Hepatology and Nutrition and the Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, CO

The Doctor's Clinic, Washington, Silverdale, WA

Biostatistics Core of Children's Hospital Colorado Research Institute, University of Colorado Denver School of Medicine, Aurora, CO.

Address correspondence and reprint requests to Jacob A. Mark, MD, Section of Gastroenterology, Hepatology and Nutrition and the Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver School of Medicine, 13123 East 16th Ave, B290 Aurora, CO 80045 (e-mail:

Received 22 May, 2018

Accepted 6 November, 2018

There was no funding source for this manuscript and the authors have no conflicts of interest to disclose. All Authors contributed to the design, data acquisition and analysis, and/or revisions of the manuscript. Jacob Mark wrote the initial draft of the manuscript. All authors approve of the final submission.

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The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,