Endoscopic remodeling of esophageal stenosis refractory to traditional endoscopic treatment

Esophageal atresia (EA), with or without tracheoesophageal fistula, is the most common congenital anomaly of the esophagus. Surgical correction is the primary treatment, however, up to 80% of patients experience anastomotic stenosis, with esophageal balloon dilation (EBD) being the first-line treatment. Unfortunately, some patients develop refractory anastomotic stenosis (RAS), defined by the presence of strictures after three EBD sessions. The endoscopic management of RAS remains controversial. Although EA itself is rare, the incidence of postoperative stricture is significant, contributing to high morbidity characterized by symptoms such as dysphagia, short stature, choking, drooling, among others. The first-line treatment for RAS is EBD, as current literature lacks clinical trials on alternative techniques. This case report highlights the successful management of refractory anastomotic stenosis in a Colombian infant using advanced endoscopic techniques.