Esophageal and Airway Treatment Center | Endoscopic management of esophageal atresia and other strictures

 Yasuda JL, Kamran A, Servin Rojas M, Hayes C, Staffa SJ, Ngo PD, Chang D, Hamilton TE, Demehri F, Mohammed S, Zendejas B, Manfredi MA. Surveillance Endoscopy in Pediatric Esophageal Atresia: Toward an Evidence-Based Algorithm. J Am Coll Surg. 2023 Dec 11. doi: 10.1097/XCS.0000000000000923. Epub ahead of print. PMID: 38078620.

Surveillance endoscopy uncovers high rates of actionable pathology even in asymptomatic children with a history of esophageal atresia. Based on the findings of the current study, we propose a pediatric EA surveillance endoscopy algorithm.

Yasuda JL, Manfredi MA. Endoscopic Management of Congenital Esophageal Defects and Associated Comorbidities. Gastrointest Endosc Clin N Am. 2023 Apr;33(2):341-361. doi: 10.1016/j.giec.2022.11.005. PMID: 36948750.

This up-to-date review explains a variety of aspects of the medical and endoscopic care of children with structural esophageal differences including esophageal atresia.

Yasuda JL, Staffa SJ, Taslitksy G, Ngo PD, Manfredi MA. Measurement of Stricture Dimensions Using a Visual Comparative Estimation Method With Biopsy Forceps During Endoscopy. J Pediatr Gastroenterol Nutr. 2023 Jan 1;76(1):77-79. doi: 10.1097/MPG.0000000000003625. Epub 2022 Sep 20. PMID: 36123760.

This study explored a simple, novel method for ensuring endoscopic estimates of stricture size are reproducible and as accurate as possible. We show that using a commonly available tool (the endoscopic biopsy forceps) as a visual reference standard of known dimensions allows the endoscopist to formulate a highly accurate estimate of stricture diameter, which is critical for selecting the appropriate endoscopic treatments for stricture.

Baghdadi O, Yasuda J, Staffa S, Ngo P, Zendejas B, Hamilton T, Jennings R, Manfredi M. Predictors and Outcomes of Fully Covered Stent Treatment for Anastomotic Esophageal Strictures in Esophageal Atresia. J Pediatr Gastroenterol Nutr. 2022 Feb 1;74(2):221-226. doi: 10.1097/MPG.0000000000003330. PMID: 34694266.

Esophageal stenting is a therapy used for certain strictures which fail to respond to conventional endoscopic dilations. This study explores the efficacy of stents in treating esophageal anastomotic strictures. 

Baghdadi O, Clark S, Ngo P, Yasuda J, Staffa S, Zendejas B, Hamilton T, Jennings R, Manfredi M. Initial Esophageal Anastomosis Diameter Predicts Treatment Outcomes in Esophageal Atresia Patients With a High Risk for Stricture Development. Front Pediatr. 2021 Sep 7;9:710363. doi: 10.3389/fped.2021.710363. PMID: 34557459; PMCID: PMC8452953.

In this study we explore the natural history of stricture development following surgical esophageal atresia repair. We showed that the severity of the stricture at 4 weeks post-op after surgical esophageal atresia repair predicts the likelihood of that stricture responding well to endoscopic therapy. Children with tight esophageal strictures (less than 3mm in diameter) at their initial 4-week endoscopy were more likely to need a repeat surgery to effectively treat their strictures. 

Yasuda JL, Svetanoff WJ, Staffa SJ, Zendejas B, Hamilton TE, Jennings RW, Ngo PD, Jason Smithers C, Manfredi MA. Prophylactic negative vacuum therapy of high-risk esophageal anastomoses in pediatric patients. J Pediatr Surg. 2021 May;56(5):944-950. doi: 10.1016/j.jpedsurg.2020.12.002. Epub 2020 Dec 13. PMID: 33342604.

The endoscopic vacuum assisted closure device (EVAC) is a device placed in the esophagus to seal esophageal leaks and perforations. In this study, we explored the utility of placing an EVAC at the same time as surgical esophageal atresia repair to prevent esophageal leaks from happening in the first place. This study showed EVACs placed at the time of initial esophageal surgery can help prevent esophageal leaks but may also increase the risk of eventual stricture later on.

Yasuda JL, Taslitsky GN, Staffa SJ, Clark SJ, Ngo PD, Hamilton TE, Zendejas B, Jennings RW, Manfredi MA. Utility of repeated therapeutic endoscopies for pediatric esophageal anastomotic strictures. Dis Esophagus. 2020 Dec 7;33(12):doaa031. doi: 10.1093/dote/doaa031. PMID: 32462191.

This study explored the utility of repeated endoscopic therapies, such as dilations, in treating esophageal strictures. We showed that serial dilation sessions are very often effective at treating and resolving esophageal strictures. 

Clark SJ, Staffa SJ, Ngo PD, Yasuda JL, Zendejas B, Hamilton TE, Jennings RW, Manfredi MA. Rules Are Meant to Be Broken: Examining the "Rule of 3" for Esophageal Dilations in Pediatric Stricture Patients. J Pediatr Gastroenterol Nutr. 2020 Jul;71(1):e1-e5. doi: 10.1097/MPG.0000000000002687. PMID: 32141993.

This study highlights how critically important it is to have dilations performed with an endoscopist who is very experienced with the dilation procedure, as the decisions involved in performing a dilation procedure (such as selecting the dilation size) ultimately matter for the stricture’s eventual outcome.

Yasuda JL, Staffa SJ, Clark SJ, Ngo PD, Zendejas B, Hamilton TE, Jennings RW, Manfredi MA. Endoscopic incisional therapy and other novel strategies for effective treatment of congenital esophageal stenosis. J Pediatr Surg. 2020 Nov;55(11):2342-2347. doi: 10.1016/j.jpedsurg.2020.01.013. Epub 2020 Jan 30. PMID: 32057439.

In this study we showed that combining dilation with endoscopic incisional cautery therapy is highly effective and safe at treating congenital esophageal strictures, with most children avoiding a surgical procedure when treated with this approach.

Yasuda JL, Staffa SJ, Ngo PD, Clark SJ, Jennings RW, Manfredi MA. Comparison of Detection Methods for Tracheoesophageal Fistulae With a Novel Method: Capnography With CO2 Insufflation. J Pediatr Gastroenterol Nutr. 2020 May;70(5):e88-e93. doi: 10.1097/MPG.0000000000002647. PMID: 31990867.

This study describes a simple method for detecting TEFs which can improve the rates of detecting these difficult-to-find fistulas.

Ngo PD, Kamran A, Clark SJ, Jennings RW, Hamilton TE, Smithers CJ, Zendejas B, Yasuda JL, Zurakowski D, Manfredi MA. Intralesional Steroid Injection Therapy for Esophageal Anastomotic Stricture Following Esophageal Atresia Repair. J Pediatr Gastroenterol Nutr. 2020 Apr;70(4):462-467. doi: 10.1097/MPG.0000000000002562. PMID: 31764412.

This study investigates the efficacy of combining steroid injections with routine endoscopic dilations in treating strictures. We found that steroid injections are safe and effective at improving stricture size across endoscopy sessions.

Manfredi MA, Clark SJ, Staffa SJ, Ngo PD, Smithers CJ, Hamilton TE, Jennings RW. Endoscopic Esophageal Vacuum Therapy: A Novel Therapy for Esophageal Perforations in Pediatric Patients. J Pediatr Gastroenterol Nutr. 2018 Dec;67(6):706-712. doi: 10.1097/MPG.0000000000002073. PMID: 29927863.

Initial description of the endoscopic esophageal vacuum therapy or EVAC to treat esophageal perforations in pediatric patients. EVAC is a novel, promising technique for the treatment of esophageal perforations in a pediatric population. This treatment is comparable to esophageal stenting in iatrogenic endoscopic therapy perforations and superior to stenting surgical perforations.

Manfredi MA, Clark SJ, Medford S, Staffa SJ, Ngo PD, Hamilton TE, Smithers CJ, Jennings RW. Endoscopic Electrocautery Incisional Therapy as a Treatment for Refractory Benign Pediatric Esophageal Strictures. J Pediatr Gastroenterol Nutr. 2018 Oct;67(4):464-468. doi: 10.1097/MPG.0000000000002008. PMID: 29697549.

Description of endoscopic incisional therapy (EIT) in the management of esophageal anastomotic strictures. This study shows that EIT is promising as an adjunct treatment option for pediatric refractory esophageal strictures and may be considered before surgical resection even in severe cases. The complication rate, albeit low, can be significant, and EIT should only be considered by experienced endoscopists in close consultation with surgery.

Manfredi MA, Jennings RW, Anjum MW, Hamilton TE, Smithers CJ, Lightdale JR. Externally removable stents in the treatment of benign recalcitrant strictures and esophageal perforations in pediatric patients with esophageal atresia. Gastrointest Endosc. 2014 Aug;80(2):246-52. doi: 10.1016/j.gie.2014.01.033. Epub 2014 Mar 18. PMID: 24650853.

Description of the outcomes of using stents in refractory strictures and esophageal perforations in children with a history of esophageal atresia. Procedural success of esophageal stent placement in the treatment of refractory strictures was 39% at 30 days and 26% at 90 days. The success rate was 80% for closure of esophageal perforations with stent therapy after dilation and 25% for perforations associated with surgical repair.