An 8-month-old girl with long-gap esophageal atresia type I managed at birth with a continuous suction catheter (replug) and a gastrostomy to start enteral nutrition.
At 2 months of life she was scheduled for corrective surgery with end-to-end anastomosis of both cables.
In the barium study one month after surgery critical stenosis was observed at the level of the anastomosis area.
Therefore, at 3.5 months of age it was decided to perform a first endoscopic dilatation.
The initial response was favorable with early restenosis, requiring a new dilation 4 weeks after the initial procedure.
Recurrence at 4 weeks, so dilation is reprogrammed.
Before this third dilatation, accidental passage of the guidewire into the mediastinum is detected, which makes it necessary not to perform dilation and PICU admission for monitoring.
Posterior right colitis was detected with probable associated abscess.
Subsequently, multiple hospitalizations due to pneumonia of probable aspiration origin were identified.
After severe respiratory symptoms and previous suspicion of moderate-severe gastroesophageal reflux, antireflux surgery was performed.
On the other hand, at 7 months of life she was programmed for endoscopic revision, finding a probable fistula with mucus emission, with suspected bronchoesophageal fistula confirmed by segmental bronchial fiberoptic study.
It was decided in a multidisciplinary session to approach the esophagus-bronchial fistula with esophageal prosthesis placed by endoscopy.
After 8 months, a 6 x 1.5 x 4 cm prosthesis was placed to partially restore the child's position. No technical problem was raised except for the need for a very specific design, without proper large cups (5 kg).
Subsequently, oral nutrition was progressively introduced.
Dysphagia and sialorrhea were not observed and there was good digestive tolerance.
However, recurrent intercurrent respiratory symptoms persist.
A barium swallow (2 months after stent placement) showed no contrast leaks or esophageal stenosis and oral nutrition was maintained.
However respiratory exacerbations persist repeatedly, so new esophageal transit is requested again, as well as two endoscopic studies where there is no evidence of recurrence of the fistula or stenosis.
However, endoscopic examination 7 months after stent placement revealed the disappearance of esophageal prosthesis remnants, absence of stenosis, and a fistula diameter of 4-5 mm was observed near the cardia.
Surgical closure of the fistula was performed, although by reopening at 2 months cervical anastomosis was performed and later gastric emptying with gastrogastroplasty was performed.
Good current clinical evolution from the respiratory and digestive point of view.
