Fig. 7.1. a A 2-month-old boy with a history of esophageal atresia. Post-operatively a stricture developed at the level of the anastomosis. Dilatation with a 7-mm balloon shows a clear waist in the balloon at the level of the stenosis. b The balloon is fully inflated and the stenosis is no longer visible
Fig. 7.1. a A 2-month-old boy with a history of esophageal atresia. Post-operatively a stricture developed at the level of the anastomosis. Dilatation with a 7-mm balloon shows a clear waist in the balloon at the level of the stenosis. b The balloon is fully inflated and the stenosis is no longer visible nosis, the procedure has shown to be most effective (Lisy et al. 1998; Sandgren and Malmfors 1998). Lang et al. (2001) compared balloon dilatation with bougienage in a paediatric population and found that in the balloon group 1-7 procedures (median 2) were required while in the bougienage group it required 1-60 (median 9, p = 0.002) procedures.
Balloon dilation is a multi-session procedure. Serial dilation has the advantage that it minimizes the risk of tears and perforation. The advantage of balloon dilation over bougienage is that, when the balloon is inflated, it exerts a radial force on the stricture opposed to the shearing forces induced by bougienage (McLean and Le Veen 1989; Yeming et al. 2002; Kim et al. 1993). This leads to a decreased risk in perforation, which in balloon dilation has been reported to be as low as 0%-1.8% compared to a 5.8% risk in bougienage (Fasulakis and Andronikou 2003; Sato et al. 1988; Said et al. 2003; Jayakrishnan and Wilkinson 2001; Sandgren and Malmfors 1998; McLean and Le Veen 1989; Kim et al. 1993).
Although a safe procedure, contraindications for balloon dilation do exist, and these are considered to be multiple (> 3) strictures, long strictures (> 5 cm), tortuous strictures, or patients with tracheoesopha-geal fistulas (Hamza et al. 2003).
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