Endoscopic management of congenital esophageal stenosis

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• 作者：Erminia Romeo^a ; ^{erminia.romeo@gmail.com"" rel=""nofollow} ; Francesca Foschia^a ; Paola de Angelis^a ; Tamara Caldaro^a ; Giovanni Federici di Abriola^a ; Rosaalba Gambitta^b ; Simona Buoni^b ; Filippo Torroni^a ; Valerio Pardi^a ; Luigi Dall'Oglio^a
• 关键词：Congenital esophageal stenosis ; Dilation ; Perforation
• 刊名：Journal of Pediatric Surgery
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：46
• 期：5
• 页码：838-841
• 全文大小：152 K

文摘

Background/Purpose

Congenital esophageal stenosis (CES) is a rare malformation. Endoscopic dilations represent a therapeutic option. This study retrospectively evaluated the efficacy and safety of a conservative treatment of CES.

Patients and Methods

Patients diagnosed with CES since 1980 by a barium study or endoscopy were reviewed. Endoscopic ultrasonography (Olympus UM-3R-20-MHz radial miniprobe, Olympus Corporation, Tokyo, Japan), available from 2001, allowed for the differential diagnosis of tracheobronchial remnants (TBR) and fibromuscular hypertrophy (FMH) CES. All children underwent conservative treatment by endoscopic dilations (hydrostatic and Savary).

Results

Forty-seven patients (20 men) had CES. Fifteen were associated with esophageal atresia; and 8, with Down syndrome. Mean age at the diagnosis was 28.3 months (range, 1 day to 146 months). Symptoms were solid food refusal, regurgitation, vomiting, and dysphagia. Congenital esophageal stenosis was located in the distal esophagus. Endoscopic ultrasonography demonstrated TBR and FMH in 6 patients. One hundred forty-eight dilations in 47 patients were performed. The stenosis healed in 45 (95.7 % ). Complications were 5 (10.6 % ) esophageal perforations, hydrostatic (3/32, or 9.3 % ), and Savary (2/116, or 1.7 % ). At follow-up, 1 patient with FMH CES and 1 patient with TBR CES required operation for persistent dysphagia.

Conclusions

The conservative treatment yielded positive outcomes in CES. Endoscopic ultrasonography allows for a correct diagnosis of TBR/FMH CES. A surgical approach should be reserved for CES not responsive to dilations.