Treatment of CES

  • Ashraf Ibrahim
  • Talal Al-Malki


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.


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


  1. 1.
    Al Shamrani J, Quesnel S, Pierrot S, Couloigner V. Endoscopic balloon dilatation of esophageal strictures in children. Int J Pediatr Otorhinolaryngol. 2011;75(11):1376–9. Scholar
  2. 2.
    Poddar U, Thaba BR. Benign esophageal stricture in infants and children: results of Savary-Gilliard bougie dilatation in 107 Indian children. Gastrointest Endosc. 2001;54(4):480–4. Scholar
  3. 3.
    Ibrahim AHM, Bazeed MF, Jamil S, Hamad HA, Abdel Raheem IM, Ashraf I. Management of congenital esophageal stenosis associated with esophageal atresia and its impact on postoperative esophageal stricture. Ann Pediatr Surg. 2016;12:36–4. Scholar
  4. 4.
    Romeo E, Foschia F, de Angelis P, Caldaro T, di Abriola GF, Gambitta R, et al. Endoscopic management of congenital esophageal stenosis. J Pediatr Surg. 2011;46:838–41. Scholar
  5. 5.
    Usui N, Kamata S, Kawahara H, Sawai T, Nakajima K, Soh H, Okada A. Usefulness of endoscopic ultrasonography in the diagnosis of congenital esophageal stenosis. J Pediatr Surg. 2002;37:1744–6. Scholar
  6. 6.
    Kouchi K, Yoshida H, Matsunage T, Ohtsuka Y, Nagatake E, Satoh Y, Terue K, Mitsunage T, et al. Endosonographic evaluation in two children with esophageal stenosis. J Pediatr Surg. 2002;37:934–6. Scholar
  7. 7.
    Teuri K, Saito T, Mitsunaga T, Nakata M, Yoshida H. Endoscopic management for congenital esophageal stenosis: a systematic review. World J Gastrointest Endosc. 2015;7(3):183–91. Scholar
  8. 8.
    Baird R, Laberge JM, Lévesque D. Anastomotic stricture after esophageal atresia repair: a critical review of recent literature. Eur J Pediatr Surg. 2013;23:204–13. Scholar
  9. 9.
    Shorter NA, Mooney DP, Vaccaro TJ, Sargent SK. Hydrostatic balloon dilatation of congenital esophageal stenosis associated with esophageal atresia. J Pediatr Surg. 2000;35:1742–5. Scholar
  10. 10.
    Kawahara H, Imura K, Yagi M, Kubota A. Clinical characteristic of congenital oesophageal stenosis distal to associated oesophageal atresia. Surgery. 2001;129:29–3.CrossRefGoogle Scholar
  11. 11.
    Yeung CK, Spitz L, Brereton RJ, Kiely EM, Leak J. Congenital esophageal stenosis due to tracheobronchial remnants: a rare but important association with esophageal atresia. J Pediatr Surg. 1992;27:852–5.CrossRefGoogle Scholar
  12. 12.
    Ibrahim AH, Al Malki TA, Hamza AF, Bahnasy AF. Congenital esophageal stenosis associated with esophageal atresia: new concepts. Pediatr Surg Int. 2007;23:533–7. Scholar
  13. 13.
    Amae S, Nio M, Kamiyama T, Ishii T, Yoshida S, Hayashi Y, et al. Clinical characteristics and management of congenital esophageal stenosis: a report on 14 cases. J Pediatr Surg. 2003;38:565–70. Scholar
  14. 14.
    Neuman B, Bender TM. Esophageal atresia/tracheoesophageal fistula and associated congenital stenosis. Pediatr Radiol. 1997;27:530–4. Scholar
  15. 15.
    Fékété CN, Backer AD, Jacob SL. Congenital esophageal stenosis, a review of 20 cases. Pediatr Surg Int. 1987;2:86–92. Scholar
  16. 16.
    Neilson IR, Croitoru DP, Guttman FM, Yossef S, Laberge JM. Distal congenital esophageal stenosis associated with esophageal atresia. J Pediatr Surg. 1991;26:478–82. Scholar
  17. 17.
    Maeda K, Hisamatsu C, Hasegawa T, Tanaka H, Okita Y. Circular myectomy for the treatment of congenital esophageal stenosis owing to tracheobronchial remnants. J Pediatr Surg. 2004;39:1765–8. Scholar
  18. 18.
    Saito T, Ise K, Kawahara Y, Yamashita M, Shimizu H, Suzuki H, Gotoh M. Congenital esophageal stenosis because of tracheobronchial remnants and treated by circular myectomy. J Pediatr Surg. 2008;43:583–5. Scholar
  19. 19.
    Martinez-Ferro M, Rubio M, Piaggio L, Laje P. Thoracoscopic approach for congenital esophageal stenosis. J Pediatr Surg. 2006;41:E5–7. Scholar
  20. 20.
    Deshpande AV, Shun A. Laparoscopic treatment of congenital esophageal stenosis due to tracheobronchial remnants in a child. J Laparoendosc Adv Surg. 2009;19:107–9. Scholar
  21. 21.
    Suzuhigashi M, Kaji T, Nogushi H, Muto M, Goto M, Mukai M, Nakame M, et al. Current characteristics and management of congenital esophageal stenosis: 40 consecutive cases from a multicenter study in the Kyushu area of Japan. Pediatr Surg Int. 2017;33:1035–40. Scholar
  22. 22.
    Antoniou D, Soutis M, Christopoulos-Geroulanos G. Anastomotic strictures following esophageal atresia repair: a 20-year experience with endoscopic balloon dilatation. J Pediatr Gastroenterol Nutr. 2010;51:464–7. Scholar
  23. 23.
    Said M, Mekki M, Golli F, Hafsa C, Braham R, Braham R, et al. Balloon dilatation of anastomotic strictures secondary to surgical repair of esophageal atresia. Br J Radiol. 2003;76:26–31. Scholar
  24. 24.
    Kim IO, Yeon KM, Kim WS, Park KW, Kim JH, Han MC. Perforation complicating balloon dilatation of esophageal strictures in infants and children. Radiology. 1993;189:741–4. Scholar
  25. 25.
    Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ. Anastomotic stricture following repair of esophageal atresia. J Pediatr Surg. 1990;25:508–11. Scholar
  26. 26.
    Tovar JA, Fragoso AC. Gastroesophageal reflux after repair of esophageal atresia. Eur J Pediatr Surg. 2013;23:175–81. Scholar
  27. 27.
    Abu-Hilal M, Hemandas AK, McPhail M, Jain G, Panagiotopoulou I, Scibelli T, Johnson CDA. Comparative analysis of safety and efficacy of different methods of tube placement for enteral feeding following major pancreatic resection. a non-randomized study. J Pancreas. 2010;11(1):8–13.Google Scholar
  28. 28.
    Stamm M. Gastrostomy: a new method. Med Newsl. 1894;65:324.Google Scholar
  29. 29.
    Gauderer MW, Ponsky J, Izant RJ. Gastrostomy without laparoscopy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15(6):872–5.CrossRefGoogle Scholar
  30. 30.
    Kwon RS, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, Mamula P, ASGE Technology Committee, et al. Enteral nutrition access device. Gastrointest Endosc. 2010;72(2):236–48. Scholar
  31. 31.
    Braegger C, Tamas D, Amil DJ, Corina H, Sanja K, Koletzko B, et al. Practical approach to pediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010;51:110–22. Scholar
  32. 32.
    Moller P, Lindberg CG, Zilling T. Gastrostomy by various techniques: evaluation of indications, outcome, and complications. Scand J Gastroenterol. 1999;34(10):1050–4. Scholar
  33. 33.
    Pisano G, Calo PG, Tatti A, Farris S, Erdas E, Licheri S, et al. Surgical gastrostomy when percutaneous endoscopic gastrostomy is not feasible: indications, results and comparison between the two procedures. Chir Ital. 2008;60(2):261–6.PubMedGoogle Scholar
  34. 34.
    Grilo A, Santos CA, Fonseca J. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting. Arq Gastroenterol. 2012;49(3):227–31.CrossRefGoogle Scholar
  35. 35.
    Ansilmo CB, Junior VT, Lopes LR, Neto JDS, et al. Surgical gastrostomy: current indications and complications in a university hospital. Rev Col Bras Cir. 2013;40(6):458–62. Scholar
  36. 36.
    Dranove JE. Focus on diagnosis: new technologies for the diagnosis of gastroesophageal reflux disease. Pediatr Rev. 2008;29:317–20. Scholar
  37. 37.
    Randolph JG, Lilly JR, Anderson KD. Surgical treatment of gastroesophageal reflux in infants. Ann Surg. 1974;180(4):479–85.CrossRefGoogle Scholar
  38. 38.
    Kultursay N. Gastro-esophageal reflux (GER) in preterms: current dilemmas and unresolved problems in diagnosis and treatment. Turk J Pediatr. 2012;54:561–9.PubMedGoogle Scholar
  39. 39.
    Colletti RB, Chritie DL, Orenstein SR. Statement of the North American Society for Pediatric Gastroenterology and Nutrition (NASPGN). Indications for pediatric esophageal pH monitoring. J Pediatr Gastroenterol Nutr. 1995;21:253–62.CrossRefGoogle Scholar
  40. 40.
    Washington N, Spensley PJ, Smith CA, Parker M, Bush D, Jackson S, et al. Dual pH probe monitoring versus single pH probe monitoring in infants on milk feeds: the impact on diagnosis. Arch Dis Child. 1999;81:309–12. Scholar
  41. 41.
    Yoo BG, Yang HK, Lee YJ, Byun SY, Kim HY, Park JH, et al. Fundoplications in neonates and infants with primary gastro-esophageal reflux. Pediatr Gastroenterol Hepatol Nutr. 2014;17(2):93–7. Scholar
  42. 42.
    Czinn SJ, Blanchard S. Gastro-esophageal reflux disease in neonates and infants: when and how to treat. Pediatr Drugs. 2013;15(1):19–27. Scholar
  43. 43.
    Castellani C, Huber-Zeyringer A, Bachmaier G, Saxena AK, Höllwarth ME. Proton pump inhibitors for reflux therapy in infants: effectiveness determined by impedance pH monitoring. Pediatr Surg Int. 2014;30:381–5. Scholar
  44. 44.
    Pacilli M, Chowdhury MM, Pierro A. The surgical treatment of gastro-esophageal reflux in neonates and infants. Semin Pediatr Surg. 2005;14(1):34–41. Scholar
  45. 45.
    Srivastava R, Bevry JG, Hall M, Downey EC, O’Gorman M, Dean JM, et al. Reflux related hospital admissions after fundoplication in children with neurological impairment: retrospective cohort study. BMJ. 2009;339:b4411. Scholar
  46. 46.
    Dala Vicchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, Engum SA. Reoperation after Nissen fundoplication in children with gastro-esophageal reflux: experience with 130 patients. Ann Surg. 1997;2226:315–21.CrossRefGoogle Scholar
  47. 47.
    Kubiak R, Spitz L, Kiely EM, Drake D, Pierro A. Effectiveness of fundoplication in early infancy. J Pediatr Surg. 1999;34:295–9. Scholar
  48. 48.
    Justo RN, Gray PH. Fundoplication in preterm infants with gastro-esophageal reflux. J Pediatr Child Health. 1991;27:250–4. Scholar
  49. 49.
    Kubiak R, Bohm-Starm E, Svcoboda D, Wessel LM. Comparison of long-term outcomes between open and laparoscopic Thal fundoplication in children. J Pediatr Surg. 2014;49:1069–74. Scholar
  50. 50.
    Jackson HT, Kane TD. Surgical management of pediatric gastroesophageal reflux disease. Res Pract. 2013;2013:863527. Scholar
  51. 51.
    Blair A, Jobe BA, John G, Hunter JG, David I, Watson DI. Esophagus and diaphragmatic hernia. In: Brunicardi FC, Billiar TR, Dunn DL, Hunter JG, Mathews JB, Polock RE, editors. Schwartz’s principles of surgery. 9th ed. New York, NY: McGraw-Hill; 2010.Google Scholar
  52. 52.
    Snyder CL, Ramachandran V, Kennedy AP, Gittes GK, Ashcraft KW, Holder TM. Efficacy of partial wrap fundoplication for gastro-esophageal reflux after repair of esophageal atresia. J Pediatr Surg. 1997;32(7):1089.
  53. 53.
    Mayr J, Sauer H, Huber A, Pilhatsch A, Ratschek M. Modified Toupet wrap for gastroesophageal reflux in childhood. Eur J Pediatr Surg. 1998;8(2):75–80. Scholar
  54. 54.
    Esposito C, Montupet P, van Der Zee D, Settimi A, Paye-Jaouen A, Centonze A, et al. Long term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. Surg Endosc. 2006;20(6):855–8. Scholar
  55. 55.
    Kubiak R, Andrews J, Grant HW. Long term outcome of laparoscopic Nissen fundoplication compared with laparoscopic Thal fundoplication in children: a prospective, randomized study. Ann Surg. 2000;35(8):1214–6. Scholar
  56. 56.
    Maxson RT, Harp S, Jackson RJ, Smith SD, Wagner CW. Delayed gastric emptying in neurologically impaired children with gastroesophageal reflux: the role of pyloroplasty. J Pediatr Surg. 1994;29(6):726–9.CrossRefGoogle Scholar
  57. 57.
    Pacilli M, Pierro A, Lindley KJ, Curry JI, Eaton S. Gastric emptying is accelerated following laparoscopic Nissen fundoplication. Eur J Pediatr Surg. 2008;18(6):395–7. Scholar
  58. 58.
    Wilson GJP, van der Zee DC, Bax NMA. Endoscopic gastrostomy placement in the child with gastroesophageal reflux: is concomitant antireflux surgery indicated? J Pediatr Surg. 2006;41(8):1441–144. Scholar
  59. 59.
    Rothenberg SS. The first decade’s experience with laparoscopic Nissen fundoplication in infants and children. J Pediatr Surg. 2005;40(1):142–7. Scholar
  60. 60.
    Kane TD, Brown MF, Chen MK. Position paper on laparoscopic antireflux operations in infants and children for gastroesophageal reflux disease. J Pediatr Surg. 2009;44(5):1034–40. Scholar
  61. 61.
    Capito C, Leclair MD, Piloquet H, Plattner V, Heloury Y, Podevin G. Long term outcome of laparoscopic Nissen-Rossetti fundoplication for neurologically impaired and normal children. Surg Endosc. 2008;22(4):875–80. Scholar
  62. 62.
    Hunter G, Smith CD, Branum GD, Waring JP, Trus TL, Cornwell M, et al. Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision. Ann Surg. 1999;230(4):595–606.CrossRefGoogle Scholar
  63. 63.
    Rothenberg SS. Laparoscopic redo Nissen fundoplication in infants and children. Surg Endosc. 2006;20(10):1518–20. Scholar
  64. 64.
    Shariff F, Kiely E, Curry J, Drake D, Pierro A, Machoney M. Outcome after laparoscopic fundoplication children under one year. J Laparoendosc Adv Surg. 2010;20(7):661–4. Scholar
  65. 65.
    Esposito C, Montupet P, Reinberg O. Laparoscopic surgery for gastroesophageal reflux disease during the first year of life. J Pediatr Surg. 2001;36(5):715–7. Scholar
  66. 66.
    Cameron BH, Cochran WJ, Mcgill CW. The uncut Collis–Nissen fundoplication: results of 79 consecutively treated high risk children. J Pediatr Surg. 1997;32(6):887–91. Scholar
  67. 67.
    Bluestone CD, Kerry R, Sieber WK. Congenital esophageal stenosis. Laryngoscope. 1969;79:1095–101. Scholar
  68. 68.
    Takamizawa S, Tsugawa C, Mouri N, Satoh S, Kanegawa K, Nishijima E, et al. Congenital esophageal stenosis: therapeutic strategy based on etiology. J Pediatr Surg. 2002;37:197–201. Scholar
  69. 69.
    Jain V, Yadav DK, Sharma S, Jana M, Gupta DK. Management of long segment congenital esophageal stenosis: a novel technique. J Indian Assoc Pediatr Surg. 2016;21:150–2. Scholar

Copyright information

© 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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