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Fujiwara Y, Kitagami H, Kikkawa T, Sakashita K, Kusumi T, Nishida Y. Esophageal cancer in an adult with congenital esophageal stenosis: a case report. Surg Case Rep 2024; 10:58. [PMID: 38467897 PMCID: PMC10928053 DOI: 10.1186/s40792-024-01858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Congenital esophageal stenosis (CES) is a rare condition. We encountered a case of esophageal cancer that developed in an adult with persistent CES. Although many studies have investigated the therapeutic outcomes and performed surveillance for symptoms after treatment for CES, few have performed long-term surveillance or reported on the development of esophageal cancer. We report this case because it is extremely rare and has important implications. CASE PRESENTATION A 45-year-old woman with worsening dysphagia was transferred to our hospital. The patient was diagnosed with CES at 5 years of age and underwent surgery at another hospital. The patient underwent esophageal dilatation for stenosis at 36 years of age. Esophagoscopy performed at our hospital revealed a circumferential ulcerated lesion and stenosis 15-29 cm from the incisors. Histological examination of the biopsy specimen revealed squamous cell carcinoma. Computed tomography (CT) revealed abnormal circumferential wall thickening in parts of the cervical and almost the entire thoracic esophagus. 18F-fluorodeoxyglucose-positron emission tomography-CT revealed increased uptake in the cervical and upper esophagus. No uptake was observed in the muscular layers of the middle or lower esophagus. Based on these findings, the patient was diagnosed with clinical stage IVB cervical and upper esophageal cancer (T3N1M1 [supraclavicular lymph nodes]). The patient underwent a total esophagectomy after neoadjuvant chemotherapy. The esophagus was markedly thickened and tightly adhered to the adjacent organs. Severe fibrosis was observed around the trachea. Marked thickening of the muscular layer was observed throughout the esophagus; histopathological examination revealed that this thickening was due to increased smooth muscle mass. No cartilage, bronchial epithelium, or glands were observed. The carcinoma extended from the cervical to the middle esophagus, oral to the stenotic region. Finally, we diagnosed the patient with esophageal cancer developing on CES of the fibromuscular thickening type. CONCLUSIONS Chronic mechanical and chemical irritations are believed to cause cancer of the upper esophagus oral to a persistent CES, suggesting the need for long-term surveillance that focuses on residual stenosis and cancer development in patients with CES.
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Affiliation(s)
- Yushi Fujiwara
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan.
| | - Hidehiko Kitagami
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Tomohiro Kikkawa
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Keita Sakashita
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Takaya Kusumi
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Yasunori Nishida
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
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2
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Yasuda JL, Manfredi MA. Endoscopic Management of Congenital Esophageal Defects and Associated Comorbidities. Gastrointest Endosc Clin N Am 2023; 33:341-361. [PMID: 36948750 DOI: 10.1016/j.giec.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The endoscopist plays a critical role in the management of patients with congenital esophageal defects. This review focuses on esophageal atresia and congenital esophageal strictures and, in particular, the endoscopic management of comorbidities related to these conditions, including anastomotic strictures, tracheoesophageal fistulas, esophageal perforations, and esophagitis surveillance. Practical aspects of endoscopic techniques for stricture management are reviewed including dilation, intralesional steroid injection, stenting, and endoscopic incisional therapy. Endoscopic surveillance for mucosal pathology is essential in this population, as patients are at high risk of esophagitis and its late complications such as Barrett's esophagus.
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Affiliation(s)
- Jessica L Yasuda
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Michael A Manfredi
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Gao Z, Wang L, Liu H, Zhang X. Congenital esophageal stenosis caused by tracheobronchial remnants: a case report. J Int Med Res 2022; 50:3000605221132704. [PMID: 36271607 PMCID: PMC9597040 DOI: 10.1177/03000605221132704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a case of congenital esophageal stenosis in which the patient underwent ineffective balloon dilatation twice and eventually required surgery. The case was initially misdiagnosed as achalasia. Pathological findings revealed tracheobronchial remnants (TBRs) in the muscular layer of strictured esophageal tissue. Most TBR strictures are located in the middle and lower thirds of the esophagus. Esophagography is the main examination method for esophageal stricture, and the appearance of the "rat tail sign" is a key diagnostic indicator. Endoscopic ultrasonography can reveal hypoechoic cartilaginous structures. The gold standards for TBR treatment include esophageal stricture resection, end-to-end esophageal anastomosis, and the construction of structures to prevent reflux. At present, endoscopic longitudinal resection and transverse anastomosis of the anterior esophageal wall with partial cartilage resection without pyloroplasty are novel and practical TBR procedures. To avoid further complications, patients with congenital esophageal stenosis should be promptly treated surgically if balloon dilatation is ineffective.
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Affiliation(s)
- Zhihong Gao
- Health Management Center, The Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
| | - Lingyan Wang
- Department of Pathology, Hebei Children’s Hospital,
Shijiazhuang, Hebei, China
| | - Huaijun Liu
- Department of Radiology, The Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
| | - Xia Zhang
- Department of Radiology, Hebei Children’s Hospital,
Shijiazhuang, Hebei, China,Xia Zhang, No. 133, Jianhua South Street,
Yuhua District, Shijiazhuang City, Hebei Province, 050031, P. R. China.
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4
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Management and clinical outcomes of congenital esophageal stenosis in pediatric patients: Experience of a tertiary referral center. J Pediatr Surg 2022; 57:518-525. [PMID: 34229876 DOI: 10.1016/j.jpedsurg.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to retrospectively investigate congenital esophageal stenosis (CES) cases managed at our institution using a non-aggressive strategy based on a step-up approach from esophageal balloon dilatations to surgery. METHODS Patients' charts with CES managed in a tertiary pediatric surgery department were retrospectively evaluated. Demographic characteristics, clinical features, pH-monitoring, imaging, and esophagoscopy results were recorded together with their treatments and outcomes. RESULTS Nineteen patients, confirmed with radiologic and endoscopic investigations, were managed. Complete symptom resolution was achieved in 14 patients by a median of five (2-15) recurrent esophageal balloon dilatations lasting for 7.5 (2-108) months. Two more patients, after 7 and 15 dilatations, had mild dysphagia, not interfering with their daily living. One patient, in whom the initial dilatation attempt with 3 atm was unsuccessful, and two patients with persistent symptoms and growth retardation despite ongoing dilatation treatment, underwent surgery. After 48 (12-132) months of follow-up, 17 patients were symptom-free. CONCLUSION Conservative treatment with esophageal balloon dilatations is an efficient and reliable modality that can be used as a first-line treatment in CES. Surgical treatment option should be used when dilatation attempt is unsuccessful, or symptoms and growth retardation persist despite dilatation treatment.
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G Fachin C, G Oliveira G, A Becker K, M Citon J, A Coelho T, I B Dos Santos A. Thoracoscopy Approach in Prone Position for Esophagoplasty in Children. J Laparoendosc Adv Surg Tech A 2021; 31:1445-1448. [PMID: 34748414 DOI: 10.1089/lap.2021.0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Congenital esophageal stenosis (CES) is a very rare clinical condition found in 1 per 25,000 to 50,000 live births. There are three histological types of CES described: tracheobronchial remnants, fibromuscular stenosis (FMS), and membranous stenosis. The first-line treatment in most cases is the conservative treatment (dilatation with a Savary bougie or balloon), but in some CES types, dilatation may be ineffective or result in esophageal perforation with serious complications or lethal outcome. Resection of the stenotic segment and end-to-end esophageal anastomosis was formerly presented as the most common surgical treatment option for CES. However, esophagoplasty is a safe and feasible alternative for surgical treatment of esophageal stenosis in children. Our aim is to report two cases of FMS submitted to thoracoscopic esophagoplasty. Both cases started with dysphagia and refusal after transition to solid diet, at 6 months old, and the radiological examination showed stricture of the distal esophagus. Esophagoplasty was performed with the patients in prone position. The stenotic esophageal wall was incised longitudinally and transverse synthesis was performed. After surgery, the patients had prompt recovery, without recurrent stenosis, remaining asymptomatic, with good diet acceptance.
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Affiliation(s)
- Camila G Fachin
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Gustavo G Oliveira
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Karin A Becker
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Júlia M Citon
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Tatiane A Coelho
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - André I B Dos Santos
- Pediatric Surgery Department of Federal University of Paraná, Curitiba, Paraná, Brazil
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Mochizuki K, Yokoi A, Urushihara N, Yabe K, Nakashima H, Kitagawa N, Maeda K, Fukumoto K, Shinkai M. Characteristics and treatment of congenital esophageal stenosis: A retrospective collaborative study from three Japanese children's hospitals. J Pediatr Surg 2021; 56:1771-1775. [PMID: 33455805 DOI: 10.1016/j.jpedsurg.2020.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/26/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND/PURPOSE There is no consensus on treatment strategy of congenital esophageal stenosis (CES). This study aimed to assess appropriateness of the treatment we have provided to patients with CES over the past four decades. METHODS We carried out a retrospective chart review of 83 CES patients treated at three children's hospitals between 1973 and 2015. Each patient underwent an initial treatment with either surgery or a series of dilation that was followed by surgery if dilation failed to improve esophageal transit. Demographic data, course of treatment, outcomes, and complications were analyzed. RESULTS During this initial treatment, 19 and 64 patients underwent surgery and dilation, respectively. Out of the 64 patients who underwent dilations as an initial treatment, 26 patients eventually required surgery. Out of all patients who required surgery (19 initial treatments + 26 failed dilations), 29 had tracheobronchial remnants and 16 had fibromuscular hypertrophy. Six patients experienced esophageal perforation during dilation and ten experienced anastomotic leakage after surgery. No patients had swallowing difficulties at the latest follow up, 141(9-324) months. CONCLUSIONS Dilation is recommended as an initial therapy, especially if histological diagnosis of CES is uncertain. Persistent swallowing difficulties after 2 series of dilation may be an indication for surgery. LEVELS OF EVIDENCE level IV.
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Affiliation(s)
- Kyoko Mochizuki
- Department of Surgery, Kanagawa Children's Medical Center(,) Yokohama, Japan.
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kiyoaki Yabe
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Hideaki Nakashima
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Norihiko Kitagawa
- Department of Surgery, Kanagawa Children's Medical Center(,) Yokohama, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Kouji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masato Shinkai
- Department of Surgery, Kanagawa Children's Medical Center(,) Yokohama, Japan
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7
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Ikeda H, Inoue H, Abad MRA, Fujiyoshi Y, Nishikawa Y, Toshimori A, Tanabe M, Shimamura Y, Sumi K, Iwaya Y, Manolakis A, Onimaru M. Diagnosis of congenital esophageal stenosis in adults and treatment with peroral endoscopic myotomy. Ann Gastroenterol 2021; 34:493-500. [PMID: 34276187 PMCID: PMC8276369 DOI: 10.20524/aog.2021.0618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022] Open
Abstract
Background Congenital esophageal stenosis (CES) in adults is a rare disorder that can present as achalasia, particularly in the distal esophagus. We describe the salient features of CES in adults and identify the feasibility and short-term outcomes of peroral endoscopic myotomy (POEM) for CES. Methods In this retrospective, single-center case series, we included 6 patients with a “misdiagnosis” of achalasia established elsewhere, ultimately diagnosed with CES and referred to our institution for POEM. Symptom improvement (clinical success rate), defined as an Eckardt Symptom Score (ESS) of <3 at 2-month follow up was assessed. Results Six patients (median age: 40 [range: 18-58] years; 4 males) were included. A long-standing history of dysphagia, ring-shaped stenosis on endoscopic examination, “lopsided hourglass” sign on barium esophagogram, and high-resolution manometry findings indicated by a compartmentalized intrabolus pressure pattern with distinction between the stenotic area and the lower esophageal sphincter were the salient features identified. POEM could not be completed in the first 2 cases due to technical challenges. All subsequent 4 patients who underwent successful POEM, exhibited improved ESS of ≤3 (clinical success rate 100%) at 2 months post-POEM. Conclusions Along with identification of salient features on several diagnostic modalities, a differential diagnosis of CES in adults must be considered in patients presenting with long-standing history of dysphagia arising from childhood and persisting into adulthood. Although favorable short-term outcomes of POEM were achieved, further evaluation is still warranted, and an inexperienced operator should not attempt POEM on CES patients due to its technical difficulties.
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Affiliation(s)
- Haruo Ikeda
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Mary Raina Angeli Abad
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Yusuke Fujiyoshi
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Yohei Nishikawa
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Akiko Toshimori
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Mayo Tanabe
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Kazuya Sumi
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Yugo Iwaya
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
| | - Anastassios Manolakis
- Department of Gastroenterology, General Hospital of Athens Evangelismos, Athens, Greece (Anastassios Manolakis)
| | - Manabu Onimaru
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan (Haruo Ikeda, Haruhiro Inoue, Mary Raina Angeli Abad, Yusuke Fujiyoshi, Yohei Nishikawa, Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Kazuya Sumi, Yugo Iwaya, Manabu Onimaru)
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Jiang Y, Pan W, Wu W, Gong Y, Lin Y, Huang S, Wang W, Sun S, Wang J. Laparoscopic-Assisted Longitudinal Incision and Transverse Anastomosis: A Novel Surgical Approach for Treatment of Esophageal Stenosis Caused by Tracheobronchial Remnants. J Laparoendosc Adv Surg Tech A 2021; 31:343-347. [PMID: 33400603 DOI: 10.1089/lap.2020.0644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To review the treatment of lower congenital esophageal stenosis caused by tracheobronchial remnants (TBR) and to introduce a novel technical approach through laparoscopic surgery. Methods: Patients with TBR who underwent surgery in our single-center from January 2016 to December 2019 were enrolled. Resection of cartilage with stenotic esophageal segment and end-to-end anastomosis was the traditional surgery. Since 2018, longitudinal incision with partial resection of cartilage loop in the anterior esophageal wall and the transverse suture was conducted endoscopically. We reviewed the treatment, followed-up with these patients, and discussed the new procedure's preponderance. Main Results: Thirteen patients underwent surgery and were followed-up for 0.5-45 months (M = 13) after surgery. Twelve patients showed good physical development with a regular diet. One patient, who was 2 weeks after the surgery, was fed by a soft diet and regularly followed-up at our clinic. In 13 cases, five patients underwent traditional laparotomy with pyloroplasty. Two patients who went through anastomotic leakage were cured by drainage and conservative treatments. Anastomotic stricture that occurred in two cases was improved by one-time of dilation. The administration time of parenteral nutrition (PN) was 9.0 ± 1.4 days. The length of hospitalization was 36.6 ± 5.2 days. Eight cases underwent the new surgical approach through laparoscopy or thoracoscopy. Pyloroplasty was avoided since the vagal close to the posterior wall of the esophagus was protected. Gastric motility disorder did not occur as expected. No leakage occurred postoperatively. The anastomotic stricture was found in six cases and improved after one to five times of dilations. The length of hospitalization dropped to 18.6 ± 6.9 days significantly (P < .001). Conclusions: Longitudinal incision and transverse anastomosis of the anterior wall of the esophagus with partial resection of cartilage without pyloroplasty through endoscopy is a novel practical surgical approach to treat patients with TBR.
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Affiliation(s)
- Yi Jiang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weihua Pan
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Wu
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Gong
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangwen Lin
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shourong Huang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weipeng Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suna Sun
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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9
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Yasuda JL, Staffa SJ, Clark SJ, Ngo PD, Zendejas B, Hamilton TE, Jennings RW, Manfredi MA. Endoscopic incisional therapy and other novel strategies for effective treatment of congenital esophageal stenosis. J Pediatr Surg 2020; 55:2342-2347. [PMID: 32057439 DOI: 10.1016/j.jpedsurg.2020.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/12/2019] [Accepted: 01/04/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND & AIMS Congenital esophageal stenosis (CES) is an inborn condition of the esophagus that can be refractory to endoscopic dilation. Surgical intervention is not curative, with patients experiencing frequent ongoing need for therapy for anastomotic stricture postoperatively. We hypothesized that novel methods of endoscopic CES management including endoscopic incisional therapy (EIT) would lead to less surgical intervention. METHODS We retrospectively reviewed the medical records of all patients with CES treated by our tertiary care center who had at least one endoscopy between July 2007 and July 2019. Statistical comparison of cohorts who underwent advanced endoscopic therapy involving EIT versus traditional endoscopic therapy with balloon dilation was performed. Primary outcome measure was need for surgical intervention. RESULTS Thirty-six patients with CES met inclusion criteria. Thirty-four ever had at least one endoscopic intervention such as balloon dilation, steroid injection, stenting, and/or endoscopic incisional therapy (EIT) at their CES. Esophageal vacuum assisted closure (EVAC) was used for treatment or prevention of esophageal leak. Odds of surgical intervention were significantly lower in the group who received therapeutic endoscopy with EIT (odds ratio (OR) 0.1; p = 0.007). Clinical feeding outcomes were similar in the endoscopic and surgical management groups. Odds of complications after therapeutic endoscopies involving EIT were significantly greater than those without EIT (odds ratio 6.39; 95% confidence interval (2.34, 17.44); p < 0.001), though our rates of esophageal leak significantly decreased over time as our use of EVAC increased (Spearman's ρ = -0.884; p = 0.004). CONCLUSION Complementary endoscopic techniques such as EIT broaden the toolbox of the treating physician and may allow for avoidance of surgery in CES. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jessica L Yasuda
- Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital, Boston, MA, United States.
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Susannah J Clark
- Department of General Surgery; Boston Children's Hospital, Boston, MA, United States
| | - Peter D Ngo
- Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital, Boston, MA, United States
| | - Benjamin Zendejas
- Department of General Surgery; Boston Children's Hospital, Boston, MA, United States
| | - Thomas E Hamilton
- Department of General Surgery; Boston Children's Hospital, Boston, MA, United States
| | - Russell W Jennings
- Department of General Surgery; Boston Children's Hospital, Boston, MA, United States
| | - Michael A Manfredi
- Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital, Boston, MA, United States
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10
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Ulukaya Durakbasa C, Kiyan G, Aydoner S, Pirim A, Seneldir H, Ozkok S, Caymaz I. Epiphrenic Diverticulum in an Infant with Congenital Esophageal Stenosis Associated with Esophageal Atresia. Medeni Med J 2020; 35:261-265. [PMID: 33110679 PMCID: PMC7584271 DOI: 10.5222/mmj.2020.22220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022] Open
Abstract
Congenital esophageal stenosis (CES) is a rare congenital disorder which may be isolated or associated with esophageal atresia (EA). It courses with esophageal outflow tract obstruction. Esophageal epiphrenic diverticulae are esophageal outpouchings above diaphragm which develop because of an underlying esophageal motor disorder. We present an infant who had CES associated with EA detected during the course of routine follow-up. She underwent several sessions of esophageal balloon dilatations for CES with some symptomatic improvement. However, an epiphrenic diverticulum (ED) developed during the course of treatment which was detected by further investigations. A surgical excision was performed with a successful outcome. An ED developed secondary to CES has not been previously reported. We have highlighted the diagnostic modalities employed, treatment options, and clinical follow-up for these two rare conditions in children.
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Affiliation(s)
- Cigdem Ulukaya Durakbasa
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Gursu Kiyan
- Marmara University Faculty of Medicine, Pendik Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Sinem Aydoner
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Ahmet Pirim
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Hatice Seneldir
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Pathology, Istanbul, Turkey
| | - Sercin Ozkok
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Ismail Caymaz
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Department of Radiology, Istanbul, Turkey
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Brzački V, Mladenović B, Jeremić L, Živanović D, Govedarović N, Dimić D, Golubović M, Stoičkov V. Congenital esophageal stenosis: a rare malformation of the foregut. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:535-547. [PMID: 31849372 PMCID: PMC6892676 DOI: 10.18999/nagjms.81.4.535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/17/2019] [Indexed: 12/30/2022]
Abstract
Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological subtypes (tracheobronchial remnants, fibromuscular thickening or fibromuscular stenosis, and membranous webbing or esophageal membrane) are described. Symptoms of CES usually appears with the introduction of the semisolid alimentation. Dysphagia is the most common symptom, but esophageal food impaction, respiratory distress or failure to thrive can be clinical manifestations of CES. Wide spectrum of differential diagnoses leads to delayed definitive diagnosis and appropriate treatment. Depends on hystological subtype of CES, some treatment procedures (dilation or segmental esophageal resection) are recommended, but individually approach is still important in terms of frequency and type of dilation procedures or type of the surgical treatment. Dysphagia can persist after the treatment and a long follow-up period is recommended. In 33% of patients with CES, a different malformations in the digestive system, but also in the other systems, are described.
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Affiliation(s)
- Vesna Brzački
- Gastroenterology and Hepatology Clinic, Clinical Center Niš, Niš, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Bojan Mladenović
- Gastroenterology and Hepatology Clinic, Clinical Center Niš, Niš, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Ljiljana Jeremić
- General Surgery Clinic, Clinical Center Niš, Niš, Serbia
- Department of Surgery, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Dragoljub Živanović
- Department of Surgery, Faculty of Medicine, University of Niš, Niš, Serbia
- Pediatric Surgery and Orthopedic Clinic, Clinical Center Niš, Niš, Serbia
| | - Nenad Govedarović
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Hematology and Clinical Immunology Clinic, Clinical Center Niš, Niš, Serbia
| | - Dragan Dimić
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Endocrinology Clinic, Clinical Center Niš, Niš, Serbia
| | - Mladjan Golubović
- Anesthesiology and Reanimation Center, Clinical Center Niš, Niš, Serbia
| | - Viktor Stoičkov
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Institute for Treatment and Rehabilitation "Niška Banja," Niš, Serbia
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Di Lorenzo C, Kaj B, Krishnan K, Moran CJ, Goldstein AM, Gee MS, Masia R. Case 29-2019: A 14-Month-Old Boy with Vomiting. N Engl J Med 2019; 381:1159-1167. [PMID: 31532965 DOI: 10.1056/nejmcpc1904049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Carlo Di Lorenzo
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Batul Kaj
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Kumar Krishnan
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Christopher J Moran
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Allan M Goldstein
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Michael S Gee
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
| | - Ricard Masia
- From the Department of Pediatrics, Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University School of Medicine - both in Columbus (C.D.L.); and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Pediatrics (B.K., C.J.M.), Medicine (K.K.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (R.M.), Harvard Medical School - both in Boston
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Wu Y, Wu C. Congenital Esophageal Atresia Associated with a Tracheobronchial Remnant. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:170-173. [PMID: 31236378 PMCID: PMC6559189 DOI: 10.5090/kjtcs.2019.52.3.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022]
Abstract
A rare case of esophageal atresia/tracheo-esophageal fistula (EA-TEF) with an associated tracheobronchial remnant (TBR) is reported and discussed herein. A 13-month-old patient was seen with a complaint of vomiting of solid food 1 year after EA-TEF repair. An esophagogram showed a tapered narrowing in the lower segment of the esophagus. A re-operation was carried out and a pathologic examination of the resected stenotic segment revealed the presence of a TBR.
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Affiliation(s)
- Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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