Endoscopic Management of Esophageal Stenosis in Children with Congenital Esophageal Atresia

Background and Study Aim: Esophageal stenosis (ES) is the most common complication associated with congenital esophageal atresia (EA). There is no consensus regarding the endoscopic management of strictures in terms of timing and techniques of dilation. The aim of this study is to describe the endoscopic approach of esophageal stenosis in children with EA admitted to our tertiary care center. Patients and Methods: A retrospective descriptive single center study was conducted. Data of all patients diagnosed with EA admitted to Woman’s and Child’s University Hospital of Verona, Italy, between 2004 and 2017, were reviewed and collected. For each patient type of EA, associated malformations, age of surgical correction, number and timing of dilations, technique of dilation and side effects of the procedure were registered. Results: Thirty-seven patients with EA were admitted to our center between 2004 and 2017. Twenty of them were excluded from the analysis for insufficient data. Five of the seventeen patients enrolled were affected by VACTERL syndrome and 3 had other congenital malformations. Twelve (70 %) subjects had tracheoesophageal fistula, all of them with type C EA. Three (18%) children presented with long gap EA. All patients underwent surgical correction within 2 months of life and an endoscopic control was performed in all of them. Eleven patients (65%), 8 with Type C EA and 3 with Type A EA, underwent endoscopic dilations because of ES. Eight of them (72%) needed more than one dilation due to anastomotic re- stenosis. Median age of first dilation was 3 months (1-12 months), whereas median age of last dilation was 6 months (1-18 months). Only in one case was used balloon dilator, whereas all other procedures were performed using Savary- Gilliard semi- rigid dilators. One patient (Type C EA with long gap) underwent surgical re-treatment due to an endoscopic complication (fistula recurrence). Six of the seventeen subjects (35%) enrolled developed long-term complications (stridor; severe esophagitis; subglottic stenosis; esophageal diverticulum; dysphagia). Conclusion: Our data confirmed that anastomotic stricture is frequent in patients with EA after surgical correction. Endoscopic management of stenosis is a safe and effective procedure that lead to a limited number of complications. Regular follow-up by a multidisciplinary team is fundamental to prevent and treat short-term and long-term complications.