Congenital oesophageal stenosis

Domínguez, Rodrigo; Zarabi, Manuchehr; Oh, Kook Sang; Bender, Thomas M.; Girdany, Bertram R.

doi:10.1016/s0009-9260(85)80056-8

Cited by 35 publications

(11 citation statements)

References 13 publications

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“…Esophageal dilatation in the pediatric patients This location is the most common location of stenosis in infants with CES [1,4]. These rings are evident after may be of only temporary benefit [3,19] and can be risky as perforations have been reported [20,21].…”

Section: Discussionmentioning

confidence: 99%

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Congenital Esophageal Stenosis: Clinical and Endoscopic Features in Adults

Younes

Johnson

1999

Dig Dis

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Background: Congenital esophageal stenosis (CES) is an uncommon anomaly that reportedly rarely goes undiagnosed until adulthood. One variant of CES includes patients with multiple cartilaginous rings described usually in the mid-distal esophagus. Methods: Ten patients with CES seen over the past 7 years were interviewed and their clinical and endoscopic records reviewed. Results: Eight patients were male and age at time of diagnosis ranged from 21 to 75 years. Meat impaction was the presenting symptom in 8 patients and 3 patients reported a relapsing history. Intermittent solid food dysphagia over extended duration (10–40 years) was reported in all patients with an estimated onset of symptoms at a mean age of 27 years (11–52 years). Endoscopically, all patients had segmental esophageal stenosis (length 2–8 cm, mean = 4.7 cm) due to ‘trachea-like’ multiple submucosal rings. Pseudodiverticulosis and distal reflux esophagitis were evident in 1 patient. Nine of 10 patients had no macroscopic esophagitis. Dilatation was performed by balloon insufflation (18 mm in 5 patients, 15 mm in 3 patients, 12 mm followed by 15 mm in a patient with a tight stricture) and by Savary dilators in 1 patient, without any complications. No patient had recurrent meat impaction on follow-up (1–7 years, mean = 3 years) after education about the condition. Conclusion: (1) We suspect CES is an under-recognized cause for intermittent, long-standing dysphagia in adults. (2) Food impaction is a frequent initial presentation. Recognition of CES is critical for appropriate patient education and planning.

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Section: Discussionmentioning

confidence: 99%

“…without atresia), usually manifests when the infant is introduced stenosis (length 2-8 cm, mean>4.7 cm) due to 'trachealike' multiple submucosal rings. Pseudodiverticulosis to solid food [3,4]. It is well documented that some patients with mild symptoms can be labeled as 'slow and distal reflux esophagitis were evident in 1 patient.…”

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confidence: 99%

Congenital Esophageal Stenosis: Clinical and Endoscopic Features in Adults

Younes

Johnson

1999

Dig Dis

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“…The presence of GER in cases of EA with CES is said to be unlikely [16]. However, others believe that it is common [4,5].…”

Section: Discussionmentioning

confidence: 99%

Congenital esophageal stenosis associated with esophageal atresia: new concepts

et al. 2007

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Congenital esophageal stenosis (CES) is suspected by a fixed intrinsic narrowing of the esophagus that affects the normal swallowing mechanism. The diagnosis is only confirmed by histopathologic picture, which may show fibromuscular disease (FMD) or tracheobronchial remnants (TBR). The latter involves ciliated pseudo stratified columnar epithelium, seromucous glands or cartilage each alone or in combination. The aim of this study is to document the usefulness of histologic picture of surgical specimens obtained from the lower esophageal pouch (LEP) during primary repair in detecting cases of CES associated with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF). Over an 8-year period, 57 consecutive cases operated upon for EA with or without TEF were subjected for histologic examination of surgical specimens obtained from the tip of the LEP. Cases that histologically showed FMD or TBR were included. The usefulness of this histologic picture as a diagnostic and therapeutic aid is assessed. Methods of treatment and outcome were also reviewed. Eight patients out of 57 (14%) had a histologic picture suggestive of CES, two with FMD, four with TBR without cartilage and two with cartilage. Out of 57 patients, 23 developed strictures, six of them had positive biopsies suggestive of CES. One patient with TBR without cartilage did not have stricture. Another case of pure atresia had LEP resection and gastric pull up showed cartilage involving the whole lower esophagus. Excluding the case of pure EA with gastric pull up, all patients suffered from feeding problems and recurrent aspiration. Fluoroscopic barium studies showed late onset minor dysmotility in five patients and late onset major dysmotility in two. All cases studied showed significant gastro-esophageal reflux (GER). Stricture was seen at the anastomotic site extending distally in the two fibromuscular cases and one case with cartilage, at the anastomotic site in three cases with TBR without cartilage. Anti reflux surgical procedures were performed in four patients without benefit in two patients with major dysmotility. Dilatation was successful in the three patients with TBR without cartilage. One patient with cartilage had resection of the anastomotic site and required frequent dilatations and is now doing well. A case of FMD did not improve after frequent dilatations and myotomy together with Nissen's fundoplication and required resection while the other case of FMD responded partially to dilatations. Cartilage in cases of CES requires surgical resection. Those with TBR without cartilage may not develop stricture. If stricture develops, it responds well to dilatation and patients have good clinical outcomes. Unlike isolated CES, GER is a significant feature in CES with EA. Anti reflux procedures should be avoided before definitive surgery for the stricture and if necessary a partial wrap with gastrostomy is recommended. CES should be considered in the etiology of anastomotic stricture. Taking a surgical specimen routinely from the tip of th...

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“…There are two types of this anomaly: a web or membranous type and a segmental type [10,15]. The segmental type of congenital esophageal stenosis may be due to fibromuscular thickening of the esophageal wall or may be secondary to tracheobronchial remnants within the esophageal wall.…”

Section: Discussionmentioning

confidence: 99%

Esophageal stenosis with esophageal atresia

Thomason

1987

Pediatr Radiol

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Esophageal atresia with tracheosophageal fistula may be associated rarely with distal esophageal stenosis. Three patients are reported with this combination of esophageal anomalies. In addition the clinical and radiologic features of 24 patients previously reported in the literature are reviewed. Careful evaluation of the distal esophagus during postoperative contrast studies in patients with esophageal atresia should be obtained to exclude distal stenosis. The presence of unrecognized distal esophageal stenosis may lead to complications of postoperative anastomotic leaks, poor healing of the anastomosis, aspiration, and impaction of a solid food bolus proximal to the stenosis.

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Congenital oesophageal stenosis

Cited by 35 publications

References 13 publications

Congenital Esophageal Stenosis: Clinical and Endoscopic Features in Adults

Congenital Esophageal Stenosis: Clinical and Endoscopic Features in Adults

Congenital esophageal stenosis associated with esophageal atresia: new concepts

Esophageal stenosis with esophageal atresia

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