ESOPHAGEAL STRICTURE FOLLOWING ESOPHAGEAL ATRESIA REPAIR - ENDOSCOPICASSESSMENT AND DILATION

A retrospective review from 1981 to 1986 was made of 51 neonates who w ere treated for congenital esophageal atresia at the Royal Alexandra H ospital for Children, Sydney, Australia. Thirty of the 51 had primary repair and 15 (50%) developed esophageal stricture requiring one or mo re dilations. Stricture dilations were performed with open-tube rigid esophagoscopes, rigid telescopes, and Jackson dilators. The number of dilations performed until the patient was asymptomatic ranged from 1 t o 12 (mean 4.5). The minimal follow-up time was 4 years. There was one esophageal perforation with full recovery following conservative mana gement. One child died of septicemia caused by continued aspiration of unknown cause. A surprising finding, contrary to other reports, was t hat stricture formation did not appear to be related to the size of th e ''gap'' found at the time of esophageal repair. Gastroesophageal ref lux, however, was an important factor. We conclude that esophageal str icture following repair of tracheoesophageal atresia can be satisfacto rily and relatively safely managed by direct vision antegrade endoscop ic dilation using graduated dilators, although treatment may be prolon ged and repeated. New esophagoscopes and dilators, in graduated sizes and designed for pediatric use, are recommended. The technique of esop hageal dilation in infants is described in detail. Pediatric laryngobr onchoesophagologists will become more involved in the care of infants born with esophageal atresia with or without tracheoesophageal fistula .