Esophageal Stricture Research Articles

Adipose Stem Cells Prevent Esophageal Strictures After Extensive Endoscopic Submucosal Dissection-Experimental Research.

Endoscopic submucosal dissection (ESD) is a pivotal technique for excision of early-stage esophageal tumors. However, its primary complication, postoperative esophageal stricture, is a significant challenge owing to the absence of effective preventive measures. Adipose-derived stem cells (ADSCs) have emerged as a promising treatment modality to address this concern. In this study, we aimed to investigate, for the first time, the efficacy of allogenic ADSC injections in preventing esophageal stenosis after ESD. We administered allogeneic ADSC injections ((same-species but different individual)) to a porcine model of ESD as a way to observe the role of ADSC in preventing esophageal stricture. We also co-cultured rats ADSCs with rats esophageal fibroblasts and esophageal mucosal epithelial cells to investigate the mechanism. ADSCs notably facilitated epithelial-mesenchymal transition (EMT) of epithelial cells. Furthermore, ADSC-conditioned medium exhibited a substantial inhibitory effect on fibroblast proliferation and migration, which was mediated by the transforming growth factor-beta pathway. Our findings underscore the potential of ADSC injections as a promising therapeutic intervention to enhance recovery and prevent post-ESD complications.

Development and Validation of the PICK-UP-STRICS Score to Predict Fibrostenosis in Patients with EoE Prior to Endoscopy.

Predicting fibrostenotic complications prior to endoscopy in eosinophilic esophagitis (EoE) is challenging and esophageal strictures and narrowing are commonly missed on endoscopy. To develop and validate a score to predict fibrostenosis in EoE patients prior to endoscopy. We leveraged a large database of newly diagnosed EoE patients. Fibrostenosis was defined as esophageal stricture, luminal narrowing, or dilation performed during the diagnostic endoscopy. Patients were randomly divided into a development and validation set. We compared features between patients with and without fibrostenosis to inform the initial model and assess predictive ability, as measured by area under curve (AUC). We tested the model in the independent validation set and generated a score to predict low, medium and high fibrostenosis risk. In 655 newly diagnosed EoE patients in the development set, fibrostenosis was associated with age ≥ 18years (OR 10.64; 95% CI 5.61-20.17), symptoms for ≥ 5years prior to diagnosis (OR 2.07; 1.32-3.24), dysphagia (OR 3.72; 1.68-8.22), food impaction (OR 1.68; 1.07-2.62), and lack of abdominal pain (OR 0.28; 0.14-0.60). The model predicted fibrostenosis (AUC = 0.841). In the validation set (n = 654), AUC was preserved (0.831). A scoring system was generated, with scores of ≤ 2 being low risk (< 10% chance of stricture), 2.5-4.5 medium risk (10-50% stricture), and 5-6 high risk (> 50%). We developed and validated the PICK-UP-STRICS score to increase suspicion and detection of fibrostenotic disease in EoE using readily available clinical features prior to endoscopy. This score may guide clinical decisions on the need of endoscopic dilation.

REVOLUTIONIZING GERD DIAGNOSIS AND TREATMENT: A COMPARATIVE ANALYSIS OF CURRENT METHODS AND AN INNOVATIVE SWALLOWABLE MEDICAL DEVICE

Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition affecting a significant portion of the global population. While GERD rarely leads to death, untreated cases can result in serious complications, including esophageal ulcers, bleeding, strictures, and Barrett’s esophagus, which increases the risk of esophageal cancer. Severe cases may require surgical intervention, costing between $8000 and $12,000. For patients with milder symptoms, proton pump inhibitors (PPIs) are often prescribed as a cost-effective treatment, averaging $163 per month, or $1500 to $2000 annually. However, PPIs are often misused, and their effectiveness is limited, reducing only about 65% of stomach acid. Misuse can lead to adverse effects, such as low stomach acid, indigestion, gas, diarrhea, constipation, and long-term risks like kidney disease, dementia, bone fractures, and cardiovascular disorders. Therefore, a more controlled approach to treatment is needed, utilizing drug delivery devices that minimize human error and comply with FDA and other regulatory standards to ensure patient safety. This paper explores recent advancements in GERD diagnosis and management, highlighting the potential of a patented device titled “A Swallowable Medical Device” that could revolutionize GERD treatment. This paper compares traditional diagnostic methods, such as endoscopy, pH monitoring, and esophageal manometry, with modern approaches like impedance-pH monitoring and high-resolution manometry. These advanced technologies allow healthcare providers to tailor treatment strategies to individual patient needs, enabling more accurate and comprehensive assessments. Additionally, a comparison with other patented devices is provided to facilitate understanding. The aim of this analysis is to offer insights into current practices, innovations, and the efficacy of the proposed “Swallowable Medical Device”. This information is made available globally to encourage further research and development in the field of GERD treatment.

An isolated organ feasibility study of deformable self-assembled magnetic anastomosis rings for esophageal stenosis anastomosis

Magnetic compression anastomosis (MCA) for esophageal stenosis requires the insertion of magnets through two channels, transoral and transgastrostomy. Herein, we designed a Y-Z deformable self-assembled magnetic anastomosis ring (Y-Z DSAMAR) for esophageal stricture anastomosis through the transoral passage only. We introduce a Y-Z DSAMAR and verify its feasibility for single-access esophageal stenosis anastomosis in isolated organs. We procured esophagi from 10 pigs. Next, we ligated the middle part of these esophagi with 7 − 0 silk to prepare an esophageal stenosis model. The linear Y-Z DSAMAR completed the deformation self-assembly and transitioned from its initial linear shape to a circular one while passing through the esophageal stenosis. The operation time, the success rate of the deformation self-assembly of Y-Z DSAMARs, and the successful MCA for esophageal stenosis were recorded. We successfully obtained a trapezoidal magnetic unit. Ten such magnetic units can self-assemble into a ring after the hard guide wire is withdrawn. The success rates for both self-assembly deformation and esophageal stenosis anastomosis were 93.33%, while that for esophageal stenosis anastomosis with successful deformation was 100%. Y-Z DSAMARs exhibit remarkable deformation-controllable characteristics. Further optimization of the operational procedure and verification through animal experiments are needed before they can be clinically applied.

Successful novel use of dupilumab for gastrointestinal involvement of idiopathic hypereosinophilic syndrome: case report and review of the literature.

Hypereosinophilic syndrome (HES) is characterized by blood and tissue hypereosinophilia leading to organ damage. Gastrointestinal involvement is the third most common manifestation. We present a patient with idiopathic HES with secondary eosinophilic esophagitis (EoE), gastritis, and enteritis, corticosteroids-dependent, azathioprine- and mepolizumab-refractory. The patient achieved clinical and histopathologic remission following dupilumab treatment. A 28year-old female presented with chronic episodic nausea and emesis since childhood and initial diagnosis of primary eosinophilic gastrointestinal disease (EGID), improved with corticosteroids, refractory to azathioprine. She was found to have peripheral eosinophilia and multifactorial anemia, with iron, B12, and folate deficiencies. Esophageal, gastric, duodenal, and terminal ileum biopsies showed significant eosinophilic infiltrate. Bone marrow biopsy at age 31 confirmed HES diagnosis. By age 32, she became total parental nutrition (TPN)-dependent. She failed trials of benralizumab and mepolizumab [anti-interleukin (IL)-5 inhibitors], and cromolyn (mast-cell stabilizer). After developing new esophageal stricture, we initiated dupilumab (IL-4/13 inhibitor), recently FDA-approved for EoE. After 9weeks, esophageal stricture, gut tissue eosinophilia, and prior intestinal ulcerations resolved. She ceased TPN and is tolerating a non-restricted diet, with complete symptom resolution. Our patient's complete remission with dupilumab shows promise for broadening its use in treating GI involvement in HES, along with primary EGIDs.

Ruminant stimulating device-associated esophageal obstruction in a Japanese black heifer with acquired esophageal diverticulum.

Esophageal diseases include esophageal obstruction, esophagitis, esophageal stricture, and esophageal diverticulum. Imaging can facilitate the selection of appropriate treatment options and assist in differential diagnosis. Esophageal obstruction in cattle is generally caused by greedy nature of chewing and swallowing of food and foreign structures, including stones, potatoes, trichobezoar, carrots, foodstuffs (i.e., hay), and rice chaff. Esophageal obstruction in cattle can also be caused by artificial procedures, and early detection and treatment are important to avoid severe esophageal injury and its associated risks. Herein, an 11-month-old Japanese black heifer presented with swelling and induration of the neck and snowball crepitation in the subcutaneous area of the left shoulder. Radiography and endoscopy revealed a spring-like foreign body in the esophagus and a cervical esophageal obstruction. Esophageal surgery confirmed that the foreign body was a ruminal mechanical stimulating brush (RB). The case died on day 8 after the initial examination. Pathological necropsy revealed that the RB had entered the esophageal diverticulum and caused esophageal obstruction. This case provides a valuable reminder about the risk of esophageal disease with oral administration procedures.

Establishing normal values for pediatric esophageal diameter on fluoroscopy.

Standardized values for esophageal diameter on fluoroscopy have not been established. These values may help in the diagnosis of long-segment and diffuse esophageal narrowing, which can sometimes be subtle and difficult to diagnose. Our objective was to establish normal values for esophageal diameter based on age for patients between 1 and 17years old. Our retrospective study included 160 patients separated into eight groups by age with documented normal upper gastrointestinal fluoroscopic examination and normal esophageal biopsy. Three readers measured esophageal diameters in the three locations and two projections. Intra-class correlation coefficients were calculated in order to gauge reader measurement agreement. Student's t-tests were used to evaluate for statistically significant differences between male and female patients. Finally, overall means and 95% confidence intervals were calculated at each esophageal level by age group. Our readers demonstrated excellent measurement agreement (ICCs > 0.75). Three individual esophageal measurements varied between the biological sexes, but there was no reliable statistically significant difference. There was a linear upward trend in esophageal diameter with age. For each age group, the means, standard deviations, and 95% confidence intervals were calculated for esophageal diameter in each location and projection. Across all included ages, the mean esophageal diameter rangedfrom 11-21mm on the anteroposterior projection and 8-17mm on the lateral. The provided ranges of normal esophageal diameters at each age and location in the pediatric population are quantitative metrics which can be used in the interpretation of fluoroscopic examinations. New reference values may lead to earlier diagnosis of esophageal pathology in the pediatric population.

AHP SO03 - The role of the specialist upper gastrointestinal (UGI) benign dietitian in the management of benign UGI disorders – a review of the outpatient referral base

Abstract Background Benign UGI disorders can negatively affect patients’ nutritional status by impacting on oral intake and/or through malabsorption. GSTT performs a high volume of benign UGI surgeries and is a tertiary referral centre for oesophageal reconstructions and complex hernias. The role of the dedicated specialist UGI benign dietitian was established in 2019 to provide dietetic expertise to the UGI multidisciplinary team (MDT). It supports patients before and after surgery with the aim of reducing post-operative complications, length of hospital stay, re-admissions and improving patient experience and quality of life. Method Outpatient referrals to the UGI benign dietetic service between 02/02/2024 and 06/06/2024 were reviewed for source of referral, reason for dietetic referral and UGI diagnosis. Results Twenty-five new referrals were received from a variety of clinical specialities (table 1). The primary UGI disorders of referrals are outlined in table 2, with complex hernia repair being the most common. Table 3 outlines the broad range referral reasons. Nutrition support referrals were received for the following disorders: achalasia, oesophageal stricture and following oesophageal perforation, hiatus hernia repair, cholecystectomy and oesophagectomy. All weight management referrals were for complex hernia repair patients. Referrals for the side-effects of UGI surgery included dietetic support with pancreatic exocrine insufficiency (pancreatectomy; distal gastrectomy), dumping syndrome (hiatus hernia repair) and delayed gastric emptying (oesophagectomy). Conclusion The role of the benign UGI dietitian requires skills and expertise in a broad range of dietetic interventions. The service is well utilised by surgical and non-surgical colleagues. Next steps for service development would be to review the impact of interventions on surgical and patient reported outcomes, and explore feasibility of patient groups to deliver dietetic advice (for example weight reduction prior to surgery) to improve capacity within the service.

A novel piglet model of esophageal stricture following variable segmental esophageal resection and re-anastomosis.

Esophageal strictures following esophageal atresia repair are a source of significant morbidity. To test new therapeutic approaches, we designed a piglet model of esophageal stricture by resecting variable lengths of esophagus with subsequent re-anastomosis. This study describes the model and validates its physiologic impact by blinded analysis of the weight gains of the piglets. A total of 24 two-week old Pietrain piglets had esophageal resections performed, ranging from 0 to 5 cm, with the goal of inducing postoperative esophageal strictures. Postoperative body-weights were evaluated by repeated analysis of variance followed by pairwise group-comparisons based on estimated marginal means. In addition, body weight was modeled by linear-mixed model regression. Different resection lengths were compared. The esophagi were evaluated postmortem for stricture. Of 24 operated piglets, 23 reached the endpoint, and 90% developed an esophageal stricture that was radiologically visible in a contrast study, as well as appreciable macroscopically in the necropsy. We found differences in pre- and postoperative body weights for all piglets (F (1, 18) = 298.54, p < 0.001), but no differences between resection lengths (F (4, 18) = 0.36, p = 0.837). Our model of postoperative esophageal stricture offers the opportunity to investigate potential treatments for strictures associated with esophageal atresia, since it reliably induces strictures and results in minimal loss of animals. The similar body weight gain in all groups indicates that stricture is mainly the result of esophageal resection and re-anastomosis, regardless of the length of the resected segment.

Performance of Endoscopic Dilation in Patients with Esophageal Stenosis due to Radiotherapy for Aerodigestive Tract Malignancy: Retrospective Cohort

Performance of Endoscopic Dilation in Patients with Esophageal Stenosis due to Radiotherapy for Aerodigestive Tract Malignancy: Retrospective Cohort

Fundoplication for Pediatric Gastroesophageal Reflux Disease: Indications, Techniques, and Outcomes.

Background This study aimed to evaluate the indications, techniques, and outcomes of fundoplication in pediatric patients with gastroesophageal reflux disease (GERD) at a tertiary hospital in Yemen. Methods A prospective cohort study was conducted at Al-Thawra Modern General Hospital, Sana'a, Yemen, between January 2015 and January 2022. The study included 45 pediatric patients under 18 years of age who underwent fundoplication for GERD. Data on demographic and clinical characteristics, surgical type, postoperative complications, and follow-up outcomes were collected and analyzed. Results The median age of the 45 pediatric patients was two years (range: two months to 10 years), with 25 males (56%) and 20 females (44%). The primary indications for fundoplication included GERD with hiatal hernia in 20 patients (44.4%), persistent symptoms despite medical management in 9 patients (20%), recurrent chest infections associated with neurological disorders in 7 patients (15.6%), esophageal stricture in 8 patients (17.8%), and both hiatal hernia and esophageal stricture in 1 patient (2.2%). Nissen fundoplication was performed in 36 patients (80%), and Thal fundoplication was performed in 9 patients (20%). Complete symptom resolution was achieved in 31 patients (68.89%). Dysphagia due to postoperative esophageal stricture was the most common complication, affecting 13 patients (29%). A structured dilatation protocol resulted in improvement after one session in four patients (30.8%), regular sessions in six patients (46.2%), and irregular sessions in three patients (23.1%). The mortality rate was two patients (5.56%), both of whom had cerebral palsy and died due to recurrent chest infections unrelated to GERD recurrence or esophageal stricture. Conclusions Fundoplication is a safe and effective surgical treatment for pediatric GERD, with a high success rate and manageable complications. A structured postoperative dilatation protocol is essential for managing esophageal strictures and improving outcomes. Early diagnosis and intervention, alongside adherence to postoperative protocols, are crucial for optimal results. Further research with larger sample sizes and long-term follow-up is recommended to confirm these findings and improve clinical practice.

Eosinophilic Esophagitis Drives Tissue Fibroblast Regenerative Programs Towards Pathologic Dysfunction

BackgroundPathologic tissue remodeling with scarring and tissue rigidity has been demonstrated in inflammatory, autoimmune, and allergic diseases. Eosinophilic esophagitis (EoE) is an allergic disease that is diagnosed and managed by repeated biopsy procurement, allowing an understanding of tissue fibroblast dysfunction. While EoE associated tissue remodeling causes clinical dysphagia, food impactions and esophageal rigidity and strictures, molecular mechanisms driving these complications remain under investigation. ObjectiveWe hypothesized that chronic EoE inflammation induces pathogenic fibroblasts with dysfunctional tissue regeneration and motility. MethodsWe used single cell RNA sequence (scRNA-Seq), fluorescence activated cell sorting analysis, and fibroblast differentiation and migration assays to decipher the induced and retained pathogenic dysfunctions in EoE versus healthy esophageal fibroblasts. ResultsDifferentiation assays demonstrated that active EoE fibroblasts retain regenerative programs for rigid cells such as chondrocytes (p<0.05) but lose healthy fibroblast capacity for soft cells such as adipocytes (p<0.01) which was reflected in biopsy immunostaining (p<0.01). EoE, but not healthy, fibroblasts have pro-inflammatory and pro-rigidity transcriptional programs on scRNA-Seq. In vivo, regenerative fibroblasts reside in perivascular regions and near the epithelial junction and, during EoE, have significantly increased migration (p<0.01). Flow analysis and functional assays demonstrated that regenerative EoE fibroblasts have decreased surface CD73 expression and activity (both p<0.05) compared to healthy, indicating aberrant ATP handling. EoE fibroblast dysfunctions were induced in healthy fibroblasts by reducing CD73 activity and rescued in EoE using adenosine repletion. ConclusionA normalization of perturbed extracellular ATP handling and CD73 could improve pathogenic fibroblast dysfunction and tissue regeneration in type 2 inflammatory diseases.

Practice patterns for eosinophilic esophagitis vary widely among Canadian gastroenterologists: a nationwide survey

Abstract Introduction Eosinophilic esophagitis (EoE) is a chronic allergic, type 2, immune-mediated condition of the oesophagus, resulting in dysmotility and oesophageal stricturing. This study aims to identify practice variation among Canadian gastroenterologists treating adults with EoE. Methods A cross-sectional, web-based survey was distributed to Canadian gastroenterologists through the Canadian Association of Gastroenterology and administrations of Canadian universities. Results Seventy gastroenterologists completed the survey, with 59% working in academic practice or research. Overall, 90% of gastroenterologists require histological evidence of EoE to establish a diagnosis of EoE, while 50% require clinical symptoms of oesophageal dysfunction; 39% of gastroenterologists take less than 5 biopsies when assessing for EoE, with variability in biopsy location. Only 51% of respondents took biopsies in every case presenting with acute food bolus. Proton pump inhibitors were the initial therapy of 70% of gastroenterologists, with 11% using topical steroids. The preferred dietary approach was the 6-food elimination diet in 36%, followed by the 2-food elimination diet in 26%. Overall, 27% of participants did not use histologic improvement and 63% did not use endoscopic improvement to evaluate treatment response. Use of EoE Endoscopic Reference Score (EREFS) is low, with 56% being either unaware of what EREFS is or never using it. Most respondents feel Canadian guidelines would be helpful in their practice. Conclusions Eosinophilic esophagitis practice patterns among Canadian gastroenterologists are variable and differ from consensus guidelines. The development of Canadian guidelines and continuing medical education content can be considered to improve the management of EoE in Canada.

Successful Thoracic Endovascular Aortic Repair of Kommerell Diverticulum to Relieve Refractory Chest Oppressions Caused by Secondary Esophageal Stricture.

Successful Thoracic Endovascular Aortic Repair of Kommerell Diverticulum to Relieve Refractory Chest Oppressions Caused by Secondary Esophageal Stricture.

Effect of castor oil on esophageal stricture in rats and expression of ST-2, neopterin proteins in corrosive burn model

Corrosive esophageal burn (CEB) is a disease with high mortality and morbidity rates. The aim of this study was to determine the efficacy of castor oil, in preventing stricture development at the experimental CEB model. In addition to studying standard histopathological damage data, neopterin, IL-33, and ST-2 proteins were also studied for the first time. Fifty Wistar-Albino rats were divided into randomized 5 groups. [Sham group (G1) (n:10), Control group (G2) (n:10), Early Stage Topical Application group (G3)(n:10), Late Stage Topical Application group (G4) (n:10), Oral Application group (G5) (n:10)]. Weight measurement, esophageal length, histopathological damage score (HDS) and total stenosis score (TSS), tissue caspase-3 and VEGF staining, tissue hydroxyproline (HYP), blood TNF-alpha, IL-6, IL-33, Neopterin, and ST-2 levels were measured. In the castor oil application groups, weight gain was observed, the acute phase reaction decreased, submucosal/tunica muscularis fibrosis (TMF) and muscularis mucosal damage (MMD) were reduced, and TSS and HDS decreased. While no significant difference was detected in the ST-2 protein, which was used for the first time in this study model, a significant increase in neopterin protein was observed in the application groups. Results indicate the nutritional contribution of castor oil, as well as its tissue healing and esophageal stricture-preventing efficacy at histopathological and immune-histochemical levels.

Clinical characteristics of patients with eosinophilic esophagitis and eosinophilic esophageal myositis based on esophageal motility.

Eosinophilic esophagitis (EoE) presents with various esophageal motility disorders, and some cases of hypercontractile esophagus (HE) are associated with eosinophilic esophageal myositis (EoEM). This study aimed to compare the clinical characteristics of patients with EoE and EoEM according to their esophageal motility. The 28 patients with EoE and 2 patients with EoEM were divided into three groups based on esophageal motility: normal motility group, hypomotility group, and spastic contraction group. The clinical characteristics of the three groups were retrospectively compared. Among the 28 patients with EoE, there were 15 with normal esophageal motility, 9 with hypomotility (2 with absent contractility, 7 with ineffective esophageal motility), and 4 with spastic contractions (1 with type III achalasia, 1 with HE, 2 with unclassifiable multipeak contractions). The two patients with EoEM had HE. Most patients in the normal and hypomotility groups had typical endoscopic findings of EoE, whereas these typical findings were less common in the spastic contraction group (P < 0.001). Four of the five patients with esophageal stricture were in the hypomotility group (P = 0.036). The therapy method significantly differed between the three groups: the normal group had more patients that responded to a proton pump inhibitor or potassium-competitive acid blocker, the hypomotility group had more patients that responded to steroids, and the spastic contraction group contained two patients treated with per-oral endoscopic myotomy (P = 0.021). The endoscopic findings and therapy methods differ between patients with EoE and EoEM based on the esophageal motility.

Oesophageal Dilation Using Combined Fluoroscopy Guidance and Neonatal Scope: Overcoming Narrow Lumen Challenges in Paediatric Cases- Two Case Reports

This report highlights the management of two complex oesophageal strictures using an innovative combined endoscopic and fluoroscopic technique. The first case involves a 12-year-old boy with epidermolysis bullosa, where conventional endoscopic methods were inadequate. The second case details a premature infant with an anastomotic stricture post-oesophageal atresia repair. Both patients underwent successful dilation with a neonatal endoscope and fluoroscopic guidance, overcoming significant technical challenges. This approach demonstrates a promising alternative for handling severe and refractory oesophageal strictures.

A case of esophageal squamous cell carcinoma with epidermization showing a unique morphology.

An 80-year-old woman with a history of endoscopic balloon dilation for esophageal stricture caused by accidental ingestion of caustic soda during infancy presented with dysphagia. Upper gastrointestinal endoscopy revealed a 10-cm-long, highly white, elevated lesion with a feathered appearance. This lesion was determined to be the cause of dysphagia and was completely resected via endoscopic submucosal dissection. Histopathological examination revealed a thick keratin layer on the surface of the stratified squamous epithelium, with a prominent granular layer underneath and some areas showing nuclear atypia. The lesion was diagnosed as a well-differentiated squamous cell carcinoma, pT1a-LPM, derived from epidermoid metaplasia. Cancer genome analysis revealed mutations in TP53 as well as amplification of MYC, FGFR1, chromosome 7, and chromosome 20q. This case suggests that epidermoid metaplasia caused by chronic irritation from an esophageal stricture may have been exacerbated by the dilation procedure.

Left aortic arch and aberrant right subclavian artery in children: spectrum of symptoms and response to surgical intervention.

Children with left aortic arch and aberrant right subclavian artery may present with either respiratory or swallowing symptoms beyond the classically described solid-food dysphagia. We describe the clinical features and outcomes of children undergoing surgical repair of an aberrant right subclavian artery. This was a retrospective review of children undergoing repair of an aberrant right subclavian artery between 2017 and 2022. Primary outcome was symptom improvement. Pre- and post-operative questionnaires were used to assess dysphagia (PEDI-EAT-10) and respiratory symptoms (PEDI-TBM-7). Paired t-test and Fisher's exact test were used to analyse symptom resolution. Secondary outcomes included perioperative outcomes, complications, and length of stay. Twenty children, median age 2 years (IQR 1-11), were included. All presented with swallowing symptoms, and 14 (70%) also experienced respiratory symptoms. Statistically significant improvements in symptoms were reported for both respiratory and swallowing symptoms. Paired (pre- and post-op) PEDI-EAT-10 and PEDI-TBM-7 scores were obtained for nine patients, resulting in mean (± SD) scores decreasing (improvement in symptoms) from 19.9 (± 9.3) to 2.4 (± 2.5) p = 0.001, and 8.7 (± 4.7) to 2.8 (± 4.0) p = 0.006, respectively. Reoperation was required in one patient due to persistent dysphagia from an oesophageal stricture. Other complications included lymphatic drainage (n = 4) and transient left vocal cord hypomobility (n = 1). Children with a left aortic arch with aberrant right subclavian artery can present with oesophageal and respiratory symptoms beyond solid food dysphagia. A thorough multidisciplinary evaluation is imperative to identify patients who can benefit from surgical repair, which appears to be safe and effective.

Effective use of semi-elemental diet in managing anastomotic leakage after surgery for esophageal stricture

Anastomotic leakage occurs in ±10% of patients after surgery for esophageal stricture. Management often requires re-surgery, which increases morbidity and mortality. This case report shows successful conservative management of anastomotic leakage with semi-elemental diet.