A gentle reminder

Abstract

As we have all come to appreciate, there are many reasonsfor reading a journal article. For many, it is a way of learningaboutatopic,andyetforothers,itisawayofconfirmingwhatis already known by the reader. I, on occasion, use journalarticles to see what my contemporaries, colleagues, andfriendsarewriting about—whatputsthe“windintheirsails.”Earning continuing education credits, formulating researchideas, and learning from different writing styles are allbenefits that come from reading an original article, review,pictorial essay, or case report. Yet the one for me that trumpsthem all is the “gentle reminder,” namely the article thatreminds me of an important concept I once knew, still tuckedin the back of my memory, but one I do not see often enoughto have at the ready. In other words, it’s the one I might misswithout the “gentle reminder.”The article titled “Congenital esophageal stenosis asso-ciated with esophageal atresia/tracheoesophageal fistula:clinical and radiologic features,” by Yoo and colleagues [1],falls easily into this last category. I am sure that some ofyou have had a case of congenital esophageal stenosis(CES) with esophageal atresia/tracheoesophageal fistula(EA/TEF)in whichyou sawthe finding,dida literaturesearchor showed a colleague, and followed up with the pediatricsurgeon to see what the lesion turned out to be. I clearlyremember a case from my fellowship, with the subsequentnoon conference discussion about complete cartilaginousrings/tracheobronchial remnants as one cause of the distalstenosis. And I recall another case 10 years later, where CESwas at first called a reflux stricture in a 2-year-old afterneonatal repair of EA/TEF, with unsuccessful balloon dilata-tion and subsequent esophageal perforation after bougienage,where in retrospect the limited postoperative esophagram atday7oflifesuggestedadistalesophagealstricture(usuallytooyoung to have already developed a reflux stricture). Then4 years after that, there was a child with a congenitalesophageal stenosis suggested by postoperative esophagramwho we are currently following as there are no clinicalsymptoms (mild distal esophageal narrowing by routinescreeningesophagramlookingforpost-anastamoticstricture).Now we are presented with the “gentle reminder”—thatcongenital esophageal stenosis is associated with EA/TEF(12% of patients in the current article), and that CES isfrequently symptomatic (45% of the CES cases in this series)and often fails balloon dilatation, the standard of care forreflux strictures. Mostly, for me, this article reminds me thatone has an invaluable opportunity to study the distalesophagus in patients with EA/TEF at the first postoperativeesophagram. We are so focused on looking for anastamoticleaks and recurrent/residual tracheoesophageal fistulae thatwemaylosesightofthefactthattherecanbeanomaliesoftheremaining distal esophagus. Even in patients who are toundergo delayed repair, with either temporizing proximalesophageal pouch decompression by an enteric tube orcervical esophagostomy, fistula takedown and gastrostomytube insertion, evaluation of the distal esophagus can be per-formed safely and effectively. By performing a gastrostomytube study, one may be able to reflux the distal esophagus tolookforCES.Theopportunityisthere,ifweremembertotakeit. Our patients will be the true beneficiaries. To Dr. Yoo andcolleagues, thank you for the “gentle reminder.”Reference