Retrograde esophageal stenting for esophageal stenosis following esophageal atresia repair

A 3-month-old girl was admitted with vomiting following esophageal repair surgery to treat congenital esophageal atresia. Endoscopy revealed stenosis ([Fig. 1]) over the anastomosis site, and she underwent three sessions of endoscopic balloon dilation. During the fourth session of esophageal dilation, dissection of the submucosal layer ([Fig. 2]) occurred after inflation of the balloon, and the procedure was postponed. The patient was subsequently fed via gastrostomy.

Fig. 1 Endoscopic view of the severe stenosis over the anastomosis.

Fig. 2 Endoscopic view of inadvertent dilation into the esophageal submucosal space.

Follow-up endoscopy after 3 months revealed further stenosis of the anastomosis site and a guidewire could not be placed via the oral route. In a retrograde approach via the gastrostomy site, the guidewire was successfully passed over the stenosis proximally ([Fig. 3, ] [Video 1]). A fully covered metal stent (Niti-S biliary covered stent, 10 × 60 mm; Taewoong Medical, Gyeonggi-do, South Korea) was successfully deployed over the guidewire via the oral route ([Fig. 4]). The stent remained in place for 1 month and was removed smoothly ([Fig. 5]).

Fig. 3 Fluoroscopic view after successful placement of a fully covered metal biliary stent over the anastomosis.

Video 1 Peroral endoscopy failed to reveal the anastomosis opening, and the guidewire could not be passed. Therefore, the endoscope was inserted via gastrostomy, the guidewire was placed using fluoroscopy, and the metal stent was deployed via the oral route.

Fig. 4 Endoscopic view from the gastric side of the stent.

Fig. 5 Endoscopic view after removal of the metal stent.

Anastomotic stricture and leakage are the two most frequent complications that occur after esophageal atresia repair [1]. Esophageal balloons are considered the preferred method to manage such complications via the oral approach, and metal stent placement is the preferred rescue therapy for refractory stenosis [2]. The present case involved a complication after esophageal dilation that may preclude subsequent endoscopic therapy, as the guidewire could not be passed via the oral route. The use of retrograde esophageal stenting as rescue therapy has been described for palliation of malignant obstruction [3] and fistula [4]. To the best of our knowledge, this is the first report to describe this technique to treat anastomosis stenosis in a case of esophageal atresia in an infant.

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^* These authors contributed equally to this work.

Publikationsverlauf

Artikel online veröffentlicht:
26. November 2020

• References

• 1 Fu YW, Hsu YJ, Yen HH. Successful treatment of anastomotic leakage by endoscopic stenting after esophageal atresia repair in an infant. Endoscopy 2020;
• 2 Ten KateCA, Tambucci R, Vlot J. et al. An international survey on anastomotic stricture management after esophageal atresia repair: considerations and advisory statements. Surg Endosc 2020;
• 3 Prachayakul V, Aswakul P, Kachintorn U. Complete obstructive esophageal cancer with esophagopleural fistula successfully treated by combined antegrade and retrograde rendezvous technique. Endoscopy 2011; 43: E354-E355
• 4 Constantinescu G, Sandru V, Ilie M. et al. Treatment of malignant esophageal fistulas: fluoroscopic placement of esophageal SEMS, endoscopically-assisted through surgical gastrostomy. A case report. J Gastrointestin Liver Dis 2016; 25: 249-252