P113 Endoscopic management in a case with esophageal anastomotic stenosis following surgical intervention for esophageal atresia

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Abstract

Introduction

Esophageal atresia(AE) is the most frequent congenital anomaly of the oesophagus. Although the survival rate of patients with AE has increased significantly in recent decades, postoperative morbidity is still high, anastomotic stenosis being the most common complication.

Objective

Endoscopic management in a case with esophageal anastomotic stenosis following surgical intervention for AE.

Case presentation

We present the case of a 9 year old girl, diagnosed on the first day of life with AE (distal esophageal-tracheal fistula – Vogt III B). The patient underwent a surgical procedure with the ligation of the fistula and end-to-end esophageal anastomosis, the immediate postoperative evolution being favourable. 4 months later,during a hospitalisation for aspiration pneumonia, the diagnosis of post-operative oesophageal stenosis is established, the patient being guided towards II nd Paediatrics Clinic Cluj-Napoca where one session of dilation of the oesophageal stenosis was performed(5 mm Savary dilator). The family didn’t comply with medical recommendations, further endoscopic treatment being cancelled. After another 9 months she is again hospitalised for an episode of aspiration pneumonia. The infant presented dysphagia for liquids and solids, being fed exclusively with formula milk. The underlying condition and the respiratory morbidities negatively influenced the nutritional status. Endoscopic dilatation of the post-operative esophageal stenosis was reinitiated. We performed 4 sessions of dilatation, 7–10 days apart, gradually increasing the diameter of the Savary dilators. Endoscopic passage at the level of stenosis was achieved and the infant tolerates now 2 soft meals/day.

Conclusions

The endoscopic management of anastomotic stenosis after AE surgery requires consistency and interdisciplinary collaboration.

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