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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2015; 7(3): 183-191
Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.183
Endoscopic management for congenital esophageal stenosis: A systematic review
Keita Terui, Takeshi Saito, Tetsuya Mitsunaga, Mitsuyuki Nakata, Hideo Yoshida
Keita Terui, Takeshi Saito, Tetsuya Mitsunaga, Mitsuyuki Nakata, Hideo Yoshida, Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan
Author contributions: Terui K, Saito T, Mitsunaga T and Nakata M performed literature review; Terui K drafted the manuscript; Yoshida H performed critical revision of the manuscript for all intellectual contents.
Conflict-of-interest: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Keita Terui, MD, PhD, Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan. kta@cc.rim.or.jp
Telephone: +81-43-2227171 Fax: +81-43-2262366
Received: August 31, 2014
Peer-review started: September 3, 2014
First decision: November 19, 2014
Revised: December 12, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: March 16, 2015
Processing time: 200 Days and 19.2 Hours
Abstract

Congenital esophageal stenosis (CES) is an extremely rare malformation, and standard treatment have not been completely established. By years of clinical research, evidence has been accumulated. We conducted systematic review to assess outcomes of the treatment for CES, especially the role of endoscopic modalities. A total of 144 literatures were screened and reviewed. CES was categorized in fibromuscular thickening, tracheobronchial remnants (TBR) and membranous web, and the frequency was 54%, 30% and 16%, respectively. Therapeutic option includes surgery and dilatation, and surgery tends to be reserved for ineffective dilatation. An essential point is that dilatation for TBR type of CES has low success rate and high rate of perforation. TBR can be distinguished by using endoscopic ultrasonography (EUS). Overall success rate of dilatation for CES with or without case selection by using EUS was 90% and 29%, respectively. Overall rate of perforation with or without case selection was 7% and 24%, respectively. By case selection using EUS, high success rate with low rate of perforation could be achieved. In conclusion, endoscopic dilatation has been established as a primary therapy for CES except TBR type. Repetitive dilatation with gradual step-up might be one of safe ways to minimize the risk of perforation.

Keywords: Esophageal stenosis; Esophageal atresia; Tracheoesophageal fistula; Esophageal perforation; Dilatation; Endosonography; Deglutition disorders; Esophagoscopes; Esophageal ring; Plummer-Vinson syndrome

Core tip: Congenital esophageal stenosis (CES) is a rare malformation consisting of 3 types; fibromuscular thickening, tracheobronchial remnants (TBR) and membranous web. Endoscopic dilatation has been established as a primary therapy for CES except TBR type. Endoscopic ultrasonography is useful to distinguish TBR from other types of CES. Repetitive dilatation with gradual step-up is recommended to minimize the risk of perforation.