Using a Miniature Stapler to Divide a Mucosal Bridge at the Anastomosis after Gastric Pull-up for Iatrogenic Tracheoesophageal Fistula

Abstract

We report the first use of a miniature stapler to divide a mucosal bridge at the gastroesophageal junction after complex esophageal atresia (EA) repair. A 4-year-old girl was referred to our center after treatment of EA elsewhere. On our initial enodoscopy, a large iatrogenic tracheoesophageal fistula had formed, prompting us to perform a tracheoplasty and gastric interposition. One year after recovery, she had dysphagia with solid food. Upon endoscopy, a mucosal bridge was noted at the gastroesophageal anastomosis. This bridge was divided under endoscopy using a 5 mm miniature stapler. No complications were noted. Upon follow-up, she had no more complaints with solid food. Our report shows that the mucosal bridges may cause dysphagia after EA repair and can be safely divided using a miniature stapler.

Endoscopic management of esophageal mucosal bridges in children with esophageal atresia

“…The endoscopic section of the EMB led to clinical improvement in 80%, while only a minority of those with “conservative” EMB improved. There are a few cases of EMB reported in children in literature ( n = 5) [ 6 , 7 , 12 ]. All were symptomatic and the mucosal bridge was cut in four of them, while it was not treated cut in one child.…”

“…To the best of our knowledge, there is no previous case report of EMB cut by electrocoagulation. There are several cases of EMB management in children with argon plasma coagulation [ 6 ], hot biopsy forceps [ 12 ], and miniature stapler [ 7 ], with no complications reported. The usefulness of a clip in a non-vascularized lesion is questionable.…”

“…Patients with EMB may be asymptomatic or may present with symptoms (chest pain, dysphagia). A few cases ( n = 4) of EMB have been reported so far in children with EA [ 6 , 7 ], and information about their role in symptoms and the need for treatment is lacking in this population.

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