Using a Miniature Stapler to Divide a Mucosal Bridge at the Anastomosis after Gastric Pull-up for Iatrogenic Tracheoesophageal Fistula.

Oliver Muensterer,Takafumi Kawano

doi:10.1055/s-0039-1678755

Oliver Muensterer, Takafumi Kawano

Open Access

https://doi.org/10.1055/s-0039-1678755

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Abstract

We report the first use of a miniature stapler to divide a mucosal bridge at the gastroesophageal junction after complex esophageal atresia (EA) repair. A 4-year-old girl was referred to our center after treatment of EA elsewhere. On our initial enodoscopy, a large iatrogenic tracheoesophageal fistula had formed, prompting us to perform a tracheoplasty and gastric interposition. One year after recovery, she had dysphagia with solid food. Upon endoscopy, a mucosal bridge was noted at the gastroesophageal anastomosis. This bridge was divided under endoscopy using a 5 mm miniature stapler. No complications were noted. Upon follow-up, she had no more complaints with solid food. Our report shows that the mucosal bridges may cause dysphagia after EA repair and can be safely divided using a miniature stapler.

Highlights

Esophageal atresia (EA) is a congenital disorder that affects approximately 1 in 2,500 neonates
We report the first use of a miniature stapler to divide a mucosal bridge at the gastroesophageal junction after complex esophageal atresia (EA) repair
Mucosal bridges after EA repair have been described in the literature before, and are one of the rare complications associated with dysphagia.[1]

Summary

Introduction

Esophageal atresia (EA) is a congenital disorder that affects approximately 1 in 2,500 neonates. The patient was a 4-year-old girl born at 33 weeks of gestation with EA and a distal tracheoesophageal fistula (TEF) She underwent surgical correction of EA on the early day of life. After her primary repair, she developed a multitude of complications, including anastomotic stricture and recurrent fistula. Endoscopy revealed a large tracheoesophageal fistula which was most likely iatrogenic after stent placement with a cuffed tracheostomy tube in place, causing erosion of the adjacent tracheoesophageal walls (►Fig. 1B). This finding prompted us to perform a tracheoplasty and gastric interposition using gastric pull-up procedure.

Discussion

Conclusion