Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features.
BACKGROUND
Congenital esophageal stenosis (CES) can be associated with esophageal atresia/tracheoesophageal fistula (EA/TEF). Because there are a variety of degrees of obstruction and symptoms of CES, it is frequently difficult to make a pre- and post-operative diagnosis of the distal CES associated with EA/TEF.


OBJECTIVE
To evaluate the clinical and radiologic features of congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula.


METHODS
We retrospectively reviewed postoperative esophagograms and medical records of 187 children (107 boys, 80 girls) who had primary repair of EA/TEF from 1992 to 2009 at our institution. We evaluated the incidence of CES, clinical findings, radiologic features and management of CES in these children.


RESULTS
CES was diagnosed in 22 of 187 EA/TEF children (12%); one child had double CES lesions, for a total of 23 lesions. Ten of those 22 children (45%) had presented with significant symptoms of esophageal obstruction. The diagnosis of CES was delayed in 10 children (45%) until 1-10 years of age. On esophagogram, CES (n = 23) was located in the distal esophagus (n = 20, 87%) or mid-esophagus (n = 3, 13%). The degree of stenosis was severe (n = 6, 26%), moderate (n = 10, 43%), or mild (n = 7, 30%). Eight children, including two with unsuccessful esophageal balloon dilatation of CES, were treated surgically. Histologic examination revealed tracheobronchial remnant (n = 7) or fibromuscular hyperplasia (n = 1). One child with surgically treated CES developed achalasia at the age of 3 years 9 months.


CONCLUSIONS
Esophagography after EA/TEF repair should be performed with a high index of suspicion for the presence of distal CES, because the diagnosis and adequate management of CES can often be delayed.
Yoo
Hye Jin
HJ
Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, 101 Daehangno, Jongno-Gu, Seoul, 110-744, South Korea.
Kim
Woo Sun
WS
Cheon
Jung-Eun
JE
Yoo
So-Young
SY
Park
Kwi-Won
KW
Jung
Sung-Eun
SE
Shin
Su-Mi
SM
Kim
In-One
IO
Yeon
Kyung Mo
KM
D002648:Child; D004065:Digestive System Abnormalities / Q000150:complications / Q000473:pathology / Q000601:surgery; D004933:Esophageal Atresia / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004940:Esophageal Stenosis / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome