Related Experiment Video
Updated: Jun 30, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Off-Label Biliary Stents for Refractory Anastomotic Strictures and Leaks after Esophageal Atresia Repair in Infants
Dmytro Rozov1, Eisa Hag2, Arcady Vachyan1
1Department of Pediatric SurgeryRambam Health Care CampusHaifaHaifa DistrictIsrael.
Insights
Fully covered biliary stents show promise as a rescue treatment for infants with refractory esophageal atresia complications, including leaks and strictures, offering a feasible option when specialized devices are unavailable.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Device Innovation
Background:
- Anastomotic strictures and leaks are common after esophageal atresia repair.
- Refractory cases often resist traditional dilation therapies.
Purpose of the Study:
- To evaluate the feasibility and outcomes of using off-label biliary stents in infants with refractory post-surgical esophageal atresia complications.
- To assess the efficacy of these stents in managing strictures and leaks.
Main Methods:
- A case series of six infants with refractory anastomotic strictures or leaks post-esophageal atresia repair.
- Endoscopic placement of fully covered, self-expanding metal biliary stents.
- Evaluation of technical and clinical success, including leak sealing and luminal patency.
Main Results:
- 100% technical success for stent placement and removal.
- 83.3% overall clinical success.
- 100% complete sealing of leaks and perforations.
- 50% sustained luminal patency in isolated refractory strictures.
- One patient required surgical revision for a long-segment stricture.
- No major adverse events over a median follow-up of 2.75 years.
Conclusions:
- Off-label biliary stents represent a feasible rescue option for complex esophageal atresia complications in infants.
- This approach may be particularly valuable when specialized pediatric devices are not available.
- Further investigation is warranted to confirm these preliminary findings.
Abstract:
Anastomotic strictures and leaks are frequent complications following the surgical repair of esophageal atresia, with a subset of patients developing refractory disease despite repeated dilations. This case series evaluates the preliminary feasibility and the outcomes of using off-label, fully covered, self-expanding, metal biliary stents in infants with refractory anastomotic strictures or leaks. Six infants treated at a tertiary referral center between 2021 and 2025 underwent endoscopic placement of fully covered self-expanding metal biliary stents. Technical success in stent placement and removal was achieved in all patients (100%). Clinical success was observed in 83.3% of patients; specifically, complete sealing of leaks and perforations was achieved in 100% of cases, while sustained luminal patency was observed in half of the isolated refractory strictures. One patient with a long-segment stricture required subsequent surgical revision. No major adverse events were identified during a median follow-up of 2.75 years. These preliminary findings suggest that biliary stents may represent a feasible rescue option for managing complex postoperative esophageal atresia complications in infants when specialized pediatric devices are unavailable.
Related Concept Videos
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD: