Intraluminal bougienage-based elongation for native-preserving salvage in long-gap esophageal atresia

Preservation of the native esophagus is the preferred goal in long-gap esophageal atresia (LGEA); however, some infants remain unsuitable for anastomosis after spontaneous growth or failure of established lengthening strategies.

We retrospectively reviewed infants with LGEA who underwent intraluminal bougienage-based elongation followed by delayed anastomosis between July 2020 and July 2025. Patients were stratified by age at initiation of elongation (<3 months vs. ≥3 months) for descriptive comparison. Outcomes were compared, and multivariable linear regression analyses were performed as exploratory analyses to assess factors associated with operative duration and postoperative esophageal dilations.

Twenty-six infants were included (≥3 months, n = 14; <3 months, n = 12). Native esophageal continuity was achieved in all patients. Infants aged ≥3 months had longer operative duration (211.3 ± 73.7 vs. 152.1 ± 47.1 min, p = 0.043) and more postoperative dilations (20.4 ± 15.3 vs. 8.4 ± 5.9, respectively; p = 0.016), while complication rates and costs were similar. In adjusted analyses, operative duration and dilations were associated with prior proximal esophageal mobilization (β = 10.51 min, p = 0.004; β = 15.11 sessions, p < 0.001), whereas age showed only borderline associations. After excluding infants with prior proximal esophageal mobilization, outcomes were comparable across age groups.

Intraluminal bougienage-based elongation may serve as a native-preserving salvage or adjunctive strategy in selected infants with LGEA who remain unsuitable for anastomosis after spontaneous growth or prior interventions.