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Treatment of CES

  • Ashraf Ibrahim
  • Talal Al-Malki
Chapter

Abstract

The main lines of treatment are dilatation and resection. CES associated with EA is much more difficult to treat than the isolated type of CES. Dilatation is attempted as a first step treatment in all patients. Current evidence supports the popularity of balloons over bougies. Bougies exceptionally are better in long and tortuous stricture and severely fibrotic ones. TBR can be distinguished before dilatation by using endoscopic ultrasonography (EUS). A guide wire is introduced under general anesthesia and endoscopic or fluoroscopic control. FMD are offered longer periods for balloon dilatations. The triad of esophageal dysmotility, GER, and stricture may require antireflux surgery and gastrostomy for better response to dilatations. A limited surgical resection and primary anastomosis is indicated if balloon dilatations failed after control of GER or if initial sufficient dilatation is not achieved or symptoms recur very soon after dilatation. The extent of CES into the distal esophagus should be accurately assessed during surgery. CES should be considered an important cause of refractory or recurrent stricture. Every effort should be made to avoid esophageal replacement unless it is compulsory indicated.

Keywords

Congenital esophageal stenosis Esophageal dilatation Refractory stricture Thal’s fundoplication Gastrostomy 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ashraf Ibrahim
    • 1
  • Talal Al-Malki
    • 2
  1. 1.Consultant Pediatric SurgeonArmed Forces Hospital, Southern Region, King Fahad Military HospitalKhamis MushaitSaudi Arabia
  2. 2.Senior Consultant Pediatric and Neonatal SurgeonAlhada Military Hospital, Vice President for D&Q, Taif UniversityTaifSaudi Arabia

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