ENDOSCOPIC BALLOON DILATION OF ANASTOMOTIC STRICTURES AFTER SURGICAL REPAIR OF ESOPHAGEAL ATRESIA
Keywords:
esophageal atresia, anastomotic strictures, endoscopic balloon dilatationAbstract
Postoperative esophageal strictures (ES) after repair of esophageal atresia are not a rare occurrence and represent a serious problem in terms of further treatment [9;3;8]. It develops in 9–79% of newborns after repair of esophageal atresia [1;5;7]. In recent years, endoscopic interventions for esophageal anastomotic strictures have been gaining increasing recognition and are considered as an alternative to repeat surgical procedures [2;4;6;8].
Objective: to analyze the results of treatment of postoperative cicatricial stenosis of the esophagus in children operated for esophageal atresia.
Materials and methods. In the Republican Educational, Therapeutic and Methodological Center for Neonatal Surgery at the Republican perinatal center (RPC) in the period from 2022 to 2023, 73 patients with cicatricial narrowing of the esophagus after esophagoplasty for its atresia were treated. There were 45 boys (62%) and 28 girls (38%). The age of the patients ranged from 1 to 11 months.
Results. As a result of treatment, in all patients with esophageal anastomosis stricture after esophagoplasty for esophageal atresia, the diameter of the anastomosis reached 10-11 mm, which corresponded to the normal lumen of the esophagus during infancy. After the first session, the volume of feeding increased 2-3 times and by the end of treatment corresponded to the physiological need. Currently, some children are observed on an outpatient basis with a control X-ray 1-2 times a year. Only one patient underwent repeated esophagoplasty due to a recurrence of esophageal stenosis.
Conclusions: We consider it advisable to perform fibroesophagoscopy in newborns who underwent esophagoplasty immediately after birth due to esophageal atresia at the time of the 1st month for early detection and timely initiation of treatment of complications.
References
Baird R, Laberge JM, Lévesque D. Anastomotic stricture after esophageal atresia repair: a critical review of recent literature. European Journal of Pediatric Surgery. 2013;23(03):204–213 (in Russ).
Allin B, Knight M, Johnson P, Burge D; BAPS-CASS. Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia. PLoS One 2014;9(08):e106149 (in Russ).
Dingemann C, Dietrich J, Zeidler J, et al. Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of 8 million. Diseases of the esophagus. 2016; 29(07):780–786 (in Russ).
Landisch RM, Foster S, Gregg D, et al. Utilizing stricture indices to predict dilation of strictures after esophageal atresia repair. The Journal of surgical research. 2017;216:172–178 (in Russ).
Okata Y, Maeda K, Bitoh Y, et al. Evaluation of the intraoperative risk factors for esophageal anastomotic complications after primary repair of esophageal atresia with tracheoesophageal fistula. Pediatric surgery international. 2016;32(09):869–873(in Russ).
Okuyama H, Koga H, Ishimaru T, et al. Current practice and outcomes of thoracoscopic esophageal atresia and tracheoesophageal fistula repair: a multi-institutional analysis in Japan. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2015;25(05):441–444 (in Russ).
Stenström P, Anderberg M, Börjesson A, Arnbjörnsson E. Dilations of anastomotic strictures over time after repair of esophageal atresia. Pediatric surgery international. 2017;33(02):191–195 (in Russ).
Hagander L, Muszynska C, Arnbjornsson E, Sandgren K. Prophylactic treatment with proton pump inhibitors in children operated on for oesophageal atresia. European Journal of Pediatric Surgery. 2012;22(02): 139–142(in Russ).
Stenström P, Anderberg M, Börjesson A, Arnbjörnsson E. Prolonged use of proton pump inhibitors as stricture prophylaxis in infants with reconstructed esophageal atresia. European Journal of Pediatric Surgery. 2017;27(02):192–195 (in Russ).
Sandgren K, Malmfors G. Balloon dilatation of oesophageal strictures in children. European Journal of Pediatric Surgery. 1998;8(01):9–11 (in Russ).
Donoso F, KassaAM, Gustafson E, Meurling S, Lilja HE. Outcome and management in infants with esophageal atresia - a single centre observational study. Journal of Pediatric Surgery. 2016;51(09):1421–1425 (in Russ).
