The treatment of post-operative and peptic esophageal strictures after esophageal atresia repair

Abstract

Nine patients, 6 weeks to 17 years of age with esophageal atresia (EA), developed esophageal strictures and were treated with 26 balloon catheter dilatations over a period of 3 years; 6 are now asymptomatic. Five of the 9 patients had suspected reflux esophagitis, confirmed in 3 by biopsy and treated medically prior to dilatation. Seven of the 9 patients had a primary anastomosis, 1 a gastric tube, and 1 a colonic interposition. Most dilatations in the group of 7 were performed with balloon (B) greater than or equal to the diameter of the distal esophagus (E) (B/E greater than or equal to 1). The 3 residually symptomatic patients include an infant dilated conservatively (B/E less than 1) to facilitate later bouginage, 1 patient with a recurrent stricture after stopping medical therapy and home bouginage, and 1 infant who had a persistent anastomotic stricture, suspected but untreated reflux esophagitis, and a perforation during the second balloon dilatation. Balloon catheter esophageal dilatation, as an alternative to bouginage, is usually a safe and effective procedure when reflux esophagitis is diagnosed and treated prior to dilatation.

Topical mitomycin-C for recalcitrant esophageal strictures: a novel endoscopic/fluoroscopic technique for safe endoluminal delivery

“…Although only reported in a limited number of children, this technique has demonstrated benefit in treating recalcitrant esophageal strictures in association with esophageal dilation [2][3][4][5][6][7]. However, because the efficacy of mitomycin-C is dependent on its direct application to submucosa at the site of mucosal disruption, a unique problem arises in targeting drug delivery to the stricture without contaminating adjacent normal enteric mucosa.…”

Anastomotic Stricture after Esophageal Atresia Repair: A Critical Review of Recent Literature

“…Dr. Folkman's group in Boston reported the first series of balloon dilatations as an alternative to bougienage for the treatment of AS after EA repair, demonstrating 66% resolution of symptoms with acceptable morbidity in nine patients. 67 Other groups followed, including Said et al who reported a series of 25 patients with AS who were all managed with balloon dilatations under fluoroscopic guidance. After a mean of four sessions, 100% of patients achieved resolution of the stricture, albeit with two patients suffering esophageal perforations.…”

Indications for Pediatric Gastrointestinal Endoscopy: A Medical Position Statement of the North American Society for Pediatric Gastroenterology and Nutrition

“…Diagnostic and therapeutic endoscopic procedures, including esophagogastroduodenoscopy, colonoscopy, dilation, variceal sclerotherapy or banding, polypectomy, and percutaneous endoscopic gastrostomy, are performed annually in thousands of infants, children, and adolescents. Pediatric endoscopy has become a valuable tool in the evaluation of gastrointestinal bleeding, dysphagia, severe pain disorders, inflammatory bowel disease, and radiographic abnormalities and for tissue diagnosis, removal of foreign bodies, and other clinical situations (1–20,21‐40,41‐61).…”