Retrograde dilatation via gastrostomy of a proximal esophagoileal anastomotic stricture in an infant with esophageal atresia.

cation after surgical repair in children with esophageal atresia. The usual treat− ment is endoscopic dilatation. If this fails, reoperation is needed. A male infant presented with type 1 esophageal atresia [1]. A gastrostomy was performed on day 1 after birth, defi− nitive repair being delayed because of the long gap. Three months later an ileoceco− coloplasty was performed, the ileum being anastomosed to the cervical esoph− agus, enabling oral feeding. At the age of 5 months, the child was admitted for ma− laise. Barium studies revealed a dilation of the proximal esophagus above a nar− row esophagoileal anastomotic stricture (l" Fig. 1). Esophagoscopy using a neonatal endo− scope (Pentax EG1870K, 5 mm diameter) confirmed the stricture. Repeated at− tempts to pass a guide wire through the stricture failed. We therefore tried to per− form a retrograde dilation through the gastrostomy orifice. The endoscope was introduced from the stomach upwards to the ileocecocoloplasty, close to the stric− ture. A guide was pushed retrogradely through the stricture (l" Fig. 2) to the mouth, and dilation was performed with Savary±Wizard dilators (diameter 5 and 7 mm). The child is now aged 34 months and is growing with no recurrence of the stric− ture. This case report shows that retrograde dilatation ± requiring preexisting gastros− tomy ± represents an alternative when esophagoscopy fails. The assumption is that it is easier to introduce the guide wire in a retrograde manner, following the direction of progressive narrowing of the stricture. Concurrent esophagoscopy and transgastrostomy gastroscopy have already been used in adult patients with postradiotherapy eosophageal stenosis [2, 3]. To the best of our knowledge only one pediatric experience has been report− ed, that of a 4−year−old boy presenting with a distal esophageal stricture follow− ing fundoplication that was dilated in a retrograde manner via a gastrostomy ori− fice [4]. Our case report demonstrates that retrograde dilation through gastros− tomy can be efficient in the treatment of narrow proximal esophageal strictures, even in young infants.