A 2-year and 6-month-old girl underwent surgery at 2 months of life for esophageal atresia type 1 long-gap with gastrostomy in the same surgical procedure.
Two months after surgery (4 months of age), esophageal dilation with hydropneumonic balloon stenosis of the anastomotic zone is required.
After a good initial response, a second dilation was performed at 4 weeks.
Since then, successive dialects were carried out with a periodicity that ranges between 4 and 8 weeks (except one occasion that required dilatation at 2 weeks of the previous period and another time when he did not report any episodes).
In addition, since birth, the patient had a marked malformation associated, which conditioned a complex nasotracheal intubation and certain problems at extubation after each process of esophageal dilation.
After a total of 14 hydroneutral dilations he decided to perform a CM session (2 years and 6 months old).
There was a very favorable response, since after a session, it has not required new dilations in the last 19 months and has not shown any type of digestive or respiratory clinic in this period.
Analysis of the series
In total, 5 prostheses were placed in 4 patients (in 1 case 2 prostheses were used).
The objective was achieved to solve the stenosis in 2 cases, there was a temporary partial response in 3 cases and in one patient a clinical worsening (for presenting an esophageal ulcer).
Three have been tapered and 2 marketed (all of the smallest caliber 23/18/23).
Three were not recipe, one partially covered and the other completely covered.
The covered prosthesis was effective in both fistulas and the partially covered one failed.
When analyzing the complications observed in PD we have seen as the most frequent significant pain (1 patient could not recover ulcer 20%/5 maintained analgesia more than 5 days) in 2 cases (2/5, 40%), severe hyperplasia (which required specific stent migration in 2 cases).
All of them have been resolved conservatively.
Regarding CM, 5 therapies have been performed in 6 patients, with 2 in 4 patients and 1 session in one.
The stenosis was definitively located in 3 cases (60%) and in another 2 it was not effective (40%).
No side effects were detected with the use of CM.
The mean time dedicated to the CM technique was 28.7 minutes (16-75).
As for the total computation of the series using both techniques, we can say that stenosis occurred in 5 out of 6 cases of EER (83.3%) and 1 out of 2 fistulas (50%); the fistula that failed
Of the two failures one has a complete esophageal closure that has forced to rethink reconstructive surgery and the other persists with oral diet through fortnightly dilatations.
Follow-up after prosthesis or final mitomycin (last included case) ranged from 8 months to 2 years.
