Preoperative Diagnosis of Congenital Esophageal Stenosis Caused by Tracheobronchial Remnants Using Miniprobe Endoscopic Ultrasonography in a Child

Abstract

Congenital esophageal stenosis (CES) can be classified into three types based on the etiology of stenosis: tracheobronchial remnants (TBRs), fibromuscular hypertrophy (FMH), and membranous diaphragm (MD). It is important to make a differential diagnosis because the therapeutic plan for CES is determined by its etiology. Most cases of FMH and MD can be managed with balloon dilatation, whereas cases of TBRs require resection and anastomosis. Thus, the preoperative distinction of TBRs is critical. Recently miniprobe endoscopic ultrasonography (EUS) with a maximum diameter of 2.5 mm has been useful for distinguishing TBRs from FMH in pediatric patients with CES. EUS shows hyperechoic lesions indicating TBR cartilage. Miniprobe EUS is recommended for choosing the correct therapeutic method for CES. We report a case of CES due to TBRs in which a preoperative diagnosis was made in a child using miniprobe EUS without any difficulties. (Pediatr Gastroenterol Hepatol Nutr 2012; 15: 52∼56)

Clinical Study of Congenital Esophageal Stenosis: Comparison according to Association of Esophageal Atresia and Tracheoesophageal Fistula

“…CES has typical findings of luminal narrowing with proximal dilatation of the esophagus on esophagography [2111217]. The pathologic type is important for planning the treatment strategy, but with esophagography, differential diagnosis among TBR, FMH and MD is impossible [3]. Endoscopy is also a commonly applied diagnostic modality, showing the location and shape of CES.…”

“…CES is a rare congenital anomaly, and its incidence has been estimated at 1 per 25,000 to 50,000 live births [1234]. Currently, the most widely used classification of CES, according to histologic abnormality of the esophageal wall, consists of three categories including tracheobronchial remnants (TBR), fibromuscular hypertrophy (FMH) and membranous diaphragm (MD) [5].…”

Congenital Esophageal Stenosis in Children: From Etiology to Prognosis

“…근위부에 다른 병변이 위 치할 경우, 특히 협착부와 매우 가까운 근위부에 선천성 식도 폐쇄증 수술의 문합부가 있는 경우 근위부의 병변에 의해 선 천성 식도 협착증이 숨겨질 수 있다 [15]. 또한, 병리 소견에 따른 분류가 치료 계획 수립에 매우 중요한데, 식도조영술로 는 기관 기관지 잔류물, 섬유근성 협착, 막성 가로막의 구분 이 불가능하다 [16]. 식도 내시경 또한 널리 이용되는 진단 방 법으로, 협착 부위 위치와 형태를 직접 확인할 수 있다.…”

“…선천성 식도 협착증의 치료는 수술적 치료와 보존적 치료 가 있으며, 원인 질환에 따라 초기 치료방침이 달라진다 [16,17]. 연구에 따라 추천하는 방법이 다르기는 하나, 기관 기관지 잔류형의 경우 풍선 확장술은 크게 도움이 되지 않으 며, 협착 부위의 절제 및 식도 단단문합술을 시행하는 것이, 수술 후 합병증이 적고, 장기적인 결과도 좋은 것으로 알려져 있다 [19].…”