Endoscopic incision plus esophageal stenting for refractory esophageal stricture in children.

A 4-year-old boy was admitted to our hospital with a 4-year history of vomiting and bucking. He had a diagnosis of esophageal atresia at Day 2 after birth and underwent surgery. Stricture formed 1 year after surgery. Prior to admission, he had undergone balloon dilation four times, stenting twice, and surgery once. Esophageal barium meal examination showed two strictures in the middle and lower segments. Informed consent was signed for endoscopic treatment of the strictures. The whole procedure was performed under general anesthesia. Incision was performed under direct visualization with a single-accessory channel endoscope (GIFQ260; Olympus, Tokyo, Japan) with a transparent cap attached to the front (D201-11804; Olympus). The first stricture site was located at 16cm from the incisors (●" Fig.1a). Radial incisions were made along a virtual line between the esophageal lumen on the anal side and the lumen on the oral side of the stricture. Sufficient incision depth was defined as the muscularis propria or to the level of the esophageal mucosa on either side of the stricture. Each part of the stricture between adjacent incisions was sliced off (●" Fig.1b). Another stricture at 22cm from the incisors (●" Fig.1c) was similarly managed. After the procedure, a fully covered retrievable metal stent (Polyflex; Willy Rüsch GMBH, Kernen, Germany) was placed at the stricture site (●" Fig.1d, ●" Video1). The whole procedure was completed uneventfully within approximately 60minutes. Nomigration occurred and the stent was removed 4 weeks later (●" Fig.2). Sustained symptom improvement was achieved. The diameters enlarged during a 6-month follow-up (●" Fig.3). Refractory stricture refers to those that do not respond to repeated dilations. While Fig.1 Endoscopic views of double esophageal stricture treated with endoscopic incision plus esophageal stenting. a Preoperative esophageal stricture at 16cm from the incisors. b Dilated esophageal lumen after incision using an insulation-tipped (IT) knife. c Preoperative esophageal stricture at 22cm from the incisors. d The fullycovered stent placed after IT-knife incision.