Use of Retrograde Esophagoscopy in Delayed Primary Esophageal Anastomosis for Isolated Esophageal Atresia

Abstract

Introduction: Preserving the native esophagus is critical for long-term swallowing function in patients with esophageal atresia (EA). However, long esophageal gaps and hidden distal esophageal pouches are frequently encountered, making primary esophageal anastomosis very difficult in cases with isolated EA. This study evaluates the efficacy of retrograde esophagoscopy for the identification of distal esophageal pouches to aid primary esophageal anastomosis in patients with isolated EA.

Material and Methods: From January 1995 to January 2007, five patients with isolated EA out of 30 patients with EA treated in our hospital were included in this study. All patients initially received a gastrostomy and distal esophagogram to evaluate distal esophageal pouches and esophageal gaps. Delayed esophageal reconstruction was performed 3 to 4 months later. During surgery for esophageal reconstruction, a 0.5 cm diameter endoscope was inserted through the gastrostomy to identify the distal esophageal pouch.

Results: Distal esophagograms found no distal esophageal pouch in 3 patients. Retrograde esophagoscopy and exploratory surgery found no distal esophageal pouch in only 1 patient. The esophageal gap ranged from 4 to 7 cm. All patients successfully received primary esophageal anastomosis except for one without a distal pouch who received colon interposition. Postoperative complications included esophageal stricture in 4 patients and gastroesophageal reflux (GER) in 3. All esophageal strictures resolved after esophageal dilatation. One patient required further fundoplication for GER.

Conclusions: Retrograde esophagoscopy is superior to distal esophagogram for the identification of distal esophageal pouches in isolated EA. In addition, retrograde esophagoscopy is excellent for the localization of distal esophageal pouches to facilitate primary end-to-end esophageal anastomosis.

Key words

isolated esophageal atresia - retrograde esophagoscopy - primary esophageal anastomosis

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