DOZ047.73: Endoscopic treatment of esophageal atresia

Abstract Aim of the Study The aim of this study was to provide an overview of endoscopic treatment in children after reconstruction of esophageal atresia. Methods This study, conducted at a single tertiary center, reviewed patients requiring endoscopic treatment during a 15-year period, from 2004 to 2018. Collected data include number, frequency, complications, and effectiveness of esophageal anastomotic dilations. Results A total of 55 children with esophageal atresia (EA) underwent upper gastrointestinal endoscopy. Of those, 37 required therapeutic endoscopy with dilation procedures for anastomotic strictures. Thirty-five patients underwent dilations using only through-the-scope (TTS) balloon (BD),1 patient using only a Savary bougie (SB), and 1 using both. A total of 126 dilations were performed using BD in 36 patients and 6 dilations using SB in 2 patients. Specifically, in children treated only with BD were performed 1 dilation in 6 children (17.1%), 2 in 6 children (17.1%), 3 in 7 children (20%), 4 in 6 children (17.1%), 5 in 6 children (17.1%), 7 in 2 children (5.7%), and 8 in 2 children (5.7%). Balloon catheter sizes ranged from 6 mm to 15 mm. In 2 patients (5.4%) stents were placed, 1 and 6 stents, respectively. Intralesional triamcinolone was injected in 8 patients (21.6%) as additional therapy. Major complications included perforation in 4 patients (10,8%), resolved with conservative treatment. All patients had clinical improvement in the follow-up. Conclusion Currently, endoscopic treatment for esophageal anastomotic stricture is the first procedure adopted in clinical practice after the surgical approach, since it is regarded safe and effective. Balloon dilations are preferred in our overview as a treatment option for esophageal anastomotic strictures. Symptom relief is reported in all cases, while the rate of complications is very low. Sometimes, refractory strictures influence the patient's quality of life and therapeutic alternatives such as stent placement should be considered.