CAPS papers
Endoscopic management of congenital esophageal stenosis

https://doi.org/10.1016/j.jpedsurg.2011.02.010Get rights and content

Abstract

Background/Purpose

Congenital esophageal stenosis (CES) is a rare malformation. Endoscopic dilations represent a therapeutic option. This study retrospectively evaluated the efficacy and safety of a conservative treatment of CES.

Patients and Methods

Patients diagnosed with CES since 1980 by a barium study or endoscopy were reviewed. Endoscopic ultrasonography (Olympus UM-3R-20-MHz radial miniprobe, Olympus Corporation, Tokyo, Japan), available from 2001, allowed for the differential diagnosis of tracheobronchial remnants (TBR) and fibromuscular hypertrophy (FMH) CES. All children underwent conservative treatment by endoscopic dilations (hydrostatic and Savary).

Results

Forty-seven patients (20 men) had CES. Fifteen were associated with esophageal atresia; and 8, with Down syndrome. Mean age at the diagnosis was 28.3 months (range, 1 day to 146 months). Symptoms were solid food refusal, regurgitation, vomiting, and dysphagia. Congenital esophageal stenosis was located in the distal esophagus. Endoscopic ultrasonography demonstrated TBR and FMH in 6 patients. One hundred forty-eight dilations in 47 patients were performed. The stenosis healed in 45 (95.7%). Complications were 5 (10.6%) esophageal perforations, hydrostatic (3/32, or 9.3%), and Savary (2/116, or 1.7%). At follow-up, 1 patient with FMH CES and 1 patient with TBR CES required operation for persistent dysphagia.

Conclusions

The conservative treatment yielded positive outcomes in CES. Endoscopic ultrasonography allows for a correct diagnosis of TBR/FMH CES. A surgical approach should be reserved for CES not responsive to dilations.

Section snippets

Patients and methods

From January 1980 to March 2010, 47 patients with CES diagnosed by a barium study or endoscopy were reviewed. Endoscopic ultrasonography (EUS) (Olympus UM-3R-20-MHz radial miniprobe) was available from 2001 for the diagnosis of TBR CES and FMH CES.

All children underwent conservative treatment by endoscopic dilations. Dilations were performed with a guidewire and spot fluoroscopy under general anesthesia. Hydrostatic dilators (Rigiflex Boston Scientific, Natick, MA, USA, with 8-, 10-, and 12-mm

Results

Forty-seven consecutive patients were diagnosed with CES. The female-to-male ratio was 1.35:1 (27 women and 20 men), and the mean age at the time of diagnosis was 28.3 months (range, 1 day to 146 months). In 8 patients (17%), the CES was associated with Down syndrome; and in 15 patients (32%), the CES was associated with type C esophageal atresia and a tracheoesophageal fistula (EA-TEF). In 32 patients (68%), the predominant clinical sign was dysphagia with regurgitation as well as solid food

Discussion

Congenital esophageal stenosis is rarely diagnosed in neonates because the onset of symptoms usually begins at the introduction of solid food at the age of 4 to 10 months. A history of dysphagia to solid food and a lack of weight gain are important in establishing a suspicion of CES.

An esophagogram generally shows a short (0.5-1 cm) lower esophageal stricture, characterized by a smooth, continuous area of concentric narrowing. Sometimes, CES is an incidental finding during an esophagoscopy or

Acknowledgment

The authors thank Geoffrey Blair for scientific support and VISES ONLUS for financial support.

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