Anastomotic esophageal strictures in children with post-surgical correction of tracheo-esophageal fistula (TEF): Our experience with endoscopic dilatation - A tertiary care center study.

Background: Improved surgical techniques, as well as pre and postoperative care, have dramatically changed survival of children with esophageal atresia (EA) with trachea-esophageal fistula (TEF) over last decades. The increase in survival caused a number of young children with post-operative esophageal strictures referred for endoscopic management. Objective: To assess efficacy and safety of endoscopic dilatation of anastomotic strictures in patients with post-surgical repair of EA and TEF. Materials and methods: We retrospectively analyzed clinical endoscopic data of 52 patients with post-surgical anastomotic strictures from March 1994 to December 2019. All procedures were performed under local anesthesia with use of fluoroscopic guidance. Outcome parameters measured included the location of stricture, number of dilations, procedural success rates, and complications such as esophageal perforation. Results: Of 52 patients analyzed, 16 (31%) underwent dilatation with SG dilators used in initial part of the study i.e., from 1994 to 2004. With the availability of CRE balloons, further patients were dilated with CRE balloon 36/52 (69%). Strictures were located centrally in 46 patients (88.6%) and eccentrically in 6 patients (11.5%). Associated pseudodiverticula above the stricture noted in 14(26.9%). The number of dilatations varied from 2 to 16 sessions, mean being 6.3 sessions. Complications secondary to procedure were observed in 7 patients with fever in 4 (7.6%), minor bleed in 2(3.8%) and perforation in one (1.9%) and were treated conservatively. We have not encountered any mortality. No significant difference between SG dilators and CRE balloon group. Conclusions: Endoscopic dilatation of post-surgical esophageal strictures in patients with EA and TEF with SG dilators CRE balloon dilatation is safe and effective with less number of complications. Endoscopic dilatation under local lignocaine anesthesia is feasible, effective and safe. [ABSTRACT FROM AUTHOR]