Jose Nieto, DO, FACG1, Ahmed M. Elmeligui, MBBCh, MD2, Ameya A. Deshmukh, BA3, Justine Broecker, MD4, Javier Tejedor-Tejada, MD5, Gustavo Villalona, MD6; 1Borland Groover Clinic, Jacksonville, FL; 2Kasr Alainy Hospital / Cairo University, Cairo, Al Jizah, Egypt; 3Midwestern University - CCOM, Downers Grove, IL; 4Mayo Clinic, Jacksonville, FL; 5Hospital Universitario Rio Hortega, Valladolid, Castilla y Leon, Spain; 6Nemours Children's Specialty Care, Jacksonville, FL
Introduction: Congenital esophageal stenosis is a rare anomaly that occurs in 1 out of 25,000 to 50,000 live births. It results from intrinsic narrowing of the esophagus secondary to congenital malformation of architecture of the esophageal wall. Diagnosis remains difficult because it might be attributed to tracheoesophageal fistula or gastroesophageal reflux disease. Endoscopic dilatation and surgical correction remain the main stay of treatment. We report a case of congenital distal esophageal stricture in an infant who underwent combined strictureplasty and dilatation to treat his condition.
Methods: An 11-month male infant presented with dysphagia to both solids and liquids and delayed weight gain. The patient underwent barium esophagram which displayed distal esophageal narrowing with a foreign body. A preliminary EGD was done and revealed a distal esophageal stricture 4 cm above esophagogastric junction with confirmed food impaction. The endoscope was advanced to the site of the esophageal stricture, where further advancement was unable to occur due to the stricture. A hybrid I-type ERBE knife was used to cut through the fibrous tissue using endo-cut 1-1-1 settings. Esophageal stricture dissection was started at 9 o`clock position ended at 3 o`clock position with noticeable dilatation of the esophageal lumen. A 0.035 guide wire was passed into the stomach and Savary dilation was used to increase the diameter of the esophageal lumen from 5 mm to 13 mm in diameter. This dilation allowed the passage of food through the lumen. Additionally, 50 units of botulinum toxin was injected at the stricture margins to induce muscle relaxation. No complications occurred during the procedure. Patient was stable after the procedure with no adverse events taking place and was discharged home on a soft/liquid diet. Follow-up revealed complete resolution of symptoms. Discussion: Endoscopic dilatation and surgical repair are the corner stones of treatment for congenital esophageal strictures. We have demonstrated the efficacy of endoscopic combined strictureplasty and dilatation as a suitable alternative in the management of congenital esophageal strictures in infants less than 1 year of age.
Endoscopic view of the distal esophageal stricture.
Hypbrid Knife I-Type strictureplasty.
Dilated esophageal lumen after strictureplasty, Savary dilation and botulinum toxin injection.
Disclosures: Jose Nieto: Boston Scientific – Consultant. ERBE – Consultant. Ahmed Elmeligui indicated no relevant financial relationships. Ameya Deshmukh indicated no relevant financial relationships. Justine Broecker indicated no relevant financial relationships. Javier Tejedor-Tejada indicated no relevant financial relationships. Gustavo Villalona indicated no relevant financial relationships.