Clinical profile and management options of children with congenital esophageal stenosis: A single center experience

Abstract

Aim:The aim of the study is to review 7 patients with congenital esophageal stenosis treated in our institution from a diagnostic and therapeutic point of view.Materials and Methods:This is a retrospective cohort study of 7 patients treated in Christian Medical College, Vellore from 2008 to 2014. The data were analyzed with regards to age at onset of symptoms, investigative findings, age at definitive treatment, pathology, modalities of treatment, and outcomes.Results:Symptoms started within the 1st year of life in all children with a median age of 4 months. The time of delay in diagnosis ranged from 8 months to 81 months with a mean period of 37 months. About 6 patients had a lower esophageal stenosis and 1 patient had a mid-esophageal stenosis. About 4 of the 7 children underwent endoscopic balloon dilatation from elsewhere, with 2 of the above 4 undergoing a myotomy for a wrongly diagnosed achalasia. The number of dilatations ranged from 2 to 7 with a mean of 4 dilatations. Resection of the stenotic segment with end to end anastomosis was employed in 6 of the 7 patients, and a transverse colon interpositioning was done in 1 patient. An antireflux procedure was performed in one patient. Histopathological examination of the resected specimen revealed tracheobronchial remnant in 3 patients, fibromuscular thickening in 3 patients, and membranous web in 1 patient. Postoperatively, 2 of the 7 patients had asymptomatic gastroesophageal reflux and 1 patient had postoperative stricture requiring one session of endoscopic balloon dilatation. The mean follow-up period was 42 months (range 18-72 months). At the time of the last follow-up, all 7 patients were able to eat solid food, and none of the children were found to have symptoms suggestive of obstruction or gastroesophageal reflux. There was a statistically significant increase in the weight for age after the operation.Conclusion:Congenital esophageal stenosis is rare and often confused with other causes of esophageal obstruction. Although endoscopic balloon dilatation offers an effective temporary relief, we feel that definitive surgery is curative. Long-term results following definitive surgery have been good, especially with respect to symptoms and weight gain.

Esophageal stenosis: A case of delayed dysphagia in an infant from northern Tanzania

“…The surgical approach depends on the site of the lesion. Stenosis close to the gastro-esophageal junction can be approached abdominally, while thoracic lesions can be managed using the right or left thoracotomy incisions [10] . Lesions higher-up around the cervical esophagus can be approached through the neck [10] .…”

“…Stenosis close to the gastro-esophageal junction can be approached abdominally, while thoracic lesions can be managed using the right or left thoracotomy incisions [10] . Lesions higher-up around the cervical esophagus can be approached through the neck [10] . Though surgery is stated to be definitive, it poses various risks such as anastomotic leaks, restenosis, gastro-esophageal reflux due to the alternation of esophago-gastric angle.…”

“…Though surgery is stated to be definitive, it poses various risks such as anastomotic leaks, restenosis, gastro-esophageal reflux due to the alternation of esophago-gastric angle. Esophageal dilatation procedures are not without risk and can cause perforation, aspiration pneumonia, or cardiac arrest [10] .…”

Evaluation and management of congenital esophageal stenosis: a rare entity

“…However, it is to be noticed that none of our patient has membranous variant, which may be more likely to be treated by dilation. [9][10][11]…”

Estenose congênita do esôfago: relato de caso

“…As estenoses esofágicas originam-se de lesões na parede do órgão levando ao espessamento de suas camadas constituintes e até mesmo fibrose, podendo apresentar etiologia congênita ou adquirida. A estenose congênita de esôfago (ECE) é uma patologia rara caracterizada por um estreitamento intrínseco do lúmen esofágico devido a uma anormalidade estrutural da parede, geralmente em seu terço inferior (Kurian, 2016;Jain, 2016).…”