Esophageal Dilation for children with Esophageal Atresia

Children with oesophageal atresia usually have their esophagus surgically repaired shortly after birth.

After surgical repair of esophageal atresia, it is common for children to develop an abnormal narrowing (stricture or stenosis) in the esophagus at the anastomosis point where the two halves were joined.

Esophageal strictures prevent the normal passage of food to the stomach.

Children with esophageal strictures may take longer to eat than usual and may show breathing difficulties whilst drinking.

Signs of esophageal stricture may only become apparent when children start eating solid foods at a later age, with solid foods becoming stuck in the esophagus leading to discomfort and difficulty swallowing.

All patients born with oesophageal atresia should be treated at a specialist center with a multidisciplinary team.

Depending on symptom severity and the child's previous history, the clinical team may obtain X-ray images of the esophagus to examine the stricture using a contrast study where a tube is passed through the nose into the esophagus and special fluid is injected and observed on X-ray.

Contrast X-ray studies show the tightness of the stricture and how easily fluid passes through it.

If there is a significant stenosis, esophageal dilation is needed to widen the narrowed area so that food can more freely pass into the stomach.

Esophageal dilation is always done under general anesthesia.

In most cases of esophageal dilation, an endoscope is used to insert a small balloon inside the stricture, which inflates to stretch open the stricture and is then removed.

Another esophageal dilation method uses the endoscope to pass a tapered elastic tube called a bougie into the esophagus to the stricture, with the doctor using several tubes one after the other that get progressively wider to gradually stretch the stricture.

After esophageal dilation, oral feeding can restart under clinical team observation, which might be required for a few hours or sometimes the child will need to stay in the hospital overnight.

A stricture can reoccur after a dilation procedure, and often the same procedure is needed multiple times before the esophagus is wide enough to pass food through it sufficiently.

Most cases of esophageal stricture can be managed with 1, 2, or 3 dilation procedures.

In rare cases of esophageal stricture, other additional treatments beyond dilation may be needed.

Follow-up support for oesophageal atresia should be both lifelong and structured.