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Esophageal stricture following esophageal atresia repair: endoscopic assessment and dilation
B Benjamin1, P Robb, M Glasson
1Ear, Nose and Throat Department, Royal Alexandra Hospital for Children, Sydney, Australia.
Insights
Congenital esophageal atresia repair can lead to strictures. Direct vision endoscopic dilation is a safe, effective treatment, though often requires multiple sessions. Gastroesophageal reflux is a key factor in stricture development.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Otolaryngology
Background:
- Congenital esophageal atresia (CEA) is a serious condition requiring surgical intervention.
- Post-operative esophageal stricture is a common complication following CEA repair.
- Effective management strategies for esophageal strictures are crucial for infant outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic dilation for esophageal strictures post-CEA repair.
- To identify factors influencing stricture formation and treatment outcomes.
- To recommend optimal management techniques and equipment for pediatric esophageal strictures.
Main Methods:
- Retrospective review of 51 neonates treated for CEA between 1981 and 1986.
- Analysis of 15 patients who developed esophageal strictures requiring dilation.
- Detailed description of the direct vision antegrade endoscopic dilation technique using graduated dilators.
Main Results:
- Fifty percent (15/30) of neonates undergoing primary repair developed esophageal strictures.
- Stricture dilation required 1 to 12 sessions (mean 4.5) for symptom resolution.
- Stricture formation was not correlated with the initial "gap" size but was associated with gastroesophageal reflux.
Conclusions:
- Direct vision antegrade endoscopic dilation is a safe and effective method for managing esophageal strictures after CEA repair.
- Treatment may be prolonged and require repeated dilations.
- Pediatric-specific esophagoscopes and graduated dilators are recommended; pediatric laryngobronchoesophagologists play a key role.
Abstract:
A retrospective review from 1981 to 1986 was made of 51 neonates who were treated for congenital esophageal atresia at the Royal Alexandra Hospital for Children, Sydney, Australia. Thirty of the 51 had primary repair and 15 (50%) developed esophageal stricture requiring one or more dilations. Stricture dilations were performed with open-tube rigid esophagoscopes, rigid telescopes, and Jackson dilators. The number of dilations performed until the patient was asymptomatic ranged from 1 to 12 (mean 4.5). The minimal follow-up time was 4 years. There was one esophageal perforation with full recovery following conservative management. One child died of septicemia caused by continued aspiration of unknown cause. A surprising finding, contrary to other reports, was the stricture formation did not appear to be related to the size of the "gap" found at the time of esophageal repair. Gastroesophageal reflux, however, was an important factor. We conclude that esophageal stricture following repair of tracheoesophageal atresia can be satisfactorily and relatively safely managed by direct vision antegrade endoscopic dilation using graduated dilators, although treatment may be prolonged and repeated. New esophagoscopes and dilators, in graduated sizes and designed for pediatric use, are recommended. The technique of esophageal dilation in infants is described in detail. Pediatric laryngobronchoesophagologists will become more involved in the care of infants born with esophageal atresia with or without tracheoesophageal fistula.