# Esophageal Stricture — GCMD Library living collection

Everything in the library about esophageal stricture — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 34 cited statements

## Episodes
### Surgical Management
- [Esophageal Dilation for children with Esophageal Atresia](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602) — video · 3:34 · [machine version](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602.md)

### Evidence & Research
- [STEPS-EA trial: Esophageal Atresia](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606) — video · 3:19 · [machine version](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606.md)

### Emerging & Future Directions
- [Growing functional intestinal tissue from stem cells with Dr. Michael Helmrath](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523) — podcast · 8:32 · [machine version](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523.md)

## Chapters
- [0:01](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=1) Introduction to esophageal atresia and post-surgical stricture formation (Ep 1)
- [1:00](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=60) Clinical presentation and symptoms of esophageal strictures (Ep 1)
- [2:00](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=120) Diagnostic imaging and contrast studies (Ep 1)
- [2:30](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=150) Esophageal dilation techniques: balloon and bougie methods (Ep 1)
- [3:15](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=195) Post-procedure management and long-term follow-up (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=0) Introduction and background on esophageal atresia strictures (Ep 2)
- [1:10](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=70) Mechanism and technique of intralesional steroid injection (Ep 2)
- [2:00](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=120) Trial design, outcomes, and participation details (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=0) Introduction to QUAD Conference and Dr. Helmrath (Ep 3)
- [0:55](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=55) Gut Complexity and Organoid Development Methods (Ep 3)
- [1:45](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=105) Organoid Structure and Nerve Integration (Ep 3)
- [3:15](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=195) Functional Demonstration of Organoid Peristalsis (Ep 3)
- [4:11](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=251) Recombination Technique and Colon Development (Ep 3)
- [4:58](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=298) Clinical Application Model: Bowel Damage and Fragment Engraftment (Ep 3)
- [6:00](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=360) Translation Pathway and Clinical Delivery Methods (Ep 3)
- [7:21](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=441) Future Clinical Applications and Timeline (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The STEPS-EA trial is an international multi-center randomized control trial initiated by the Sophia Children's Hospital in Rotterdam with cooperation from the European Reference Network ERICA. — Anfleur von Hall (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=0)
- The standard treatment for esophageal atresia is surgery with an end-to-end anastomosis to restore continuity. — Anfleur von Hall (clinical) [Ep 2 · 0:40](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=40)
- Stricture formation remains the most frequent post-operative complication in more than half of esophageal atresia cases. — Anfleur von Hall (epidemiological) [Ep 2 · 0:55](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=55)
- The current standard treatment for esophageal stricture is endoscopic dilatation either by bouginage or by balloon dilatation. — Anfleur von Hall (clinical) [Ep 2 · 1:10](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=70)
- Worldwide, balloon dilatation is most frequently used for esophageal strictures, which is why it has been chosen as the standard procedure for the intervention in this study. — Anfleur von Hall (clinical) [Ep 2 · 1:20](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=80)
- Intralesional steroid injections are an adjuvant treatment to endoscopic dilatation, where mostly triamcinolone is used. — Anfleur von Hall (clinical) [Ep 2 · 1:35](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=95)
- Steroids are thought to inhibit the formation of collagen, enhance its breakdown, and decrease fibrotic healing, thereby inhibiting scar formation and making stenosis less likely to recur. — Anfleur von Hall (clinical) [Ep 2 · 1:45](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=105)
- Each of the four quadrants of the stricture will be injected with steroid. — Anfleur von Hall (clinical) [Ep 2 · 1:55](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=115)
- The trial will investigate three main topics: effectiveness, safety, and cost-effectiveness of intralesional steroid injection. — Anfleur von Hall (clinical) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=120)
- 110 children born with esophageal atresia are needed to prove the effectiveness of the steroid injection. — Anfleur von Hall (clinical) [Ep 2 · 2:10](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=130)
- Study group A will be injected with triamcinolone and then undergo balloon dilatation, while study group B will only undergo balloon dilatation as part of standard of care. — Anfleur von Hall (clinical) [Ep 2 · 2:18](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=138)
- All patients undergo an esophagram prior to dilatation as part of standard of care. — Anfleur von Hall (clinical) [Ep 2 · 2:35](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=155)
- A second esophagram will be performed to objectify the effectiveness of the intervention on the length and diameter of the stricture. — Anfleur von Hall (clinical) [Ep 2 · 2:42](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=162)
- Physical length and weight will be measured at 4 time points throughout the 6-month study period to investigate possible systemic side effects of a single dose steroid injection. — Anfleur von Hall (clinical) [Ep 2 · 2:52](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=172)
- At the end of the follow-up period, a small scale hair sample will be collected to measure cortisol levels to investigate possible systemic effects and safety of the intralesional steroid injection. — Anfleur von Hall (clinical) [Ep 2 · 3:03](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=183)
- During the follow-up period, parents will be asked to fill out an online questionnaire about disease-related expenses and dysphagia. — Anfleur von Hall (clinical) [Ep 2 · 3:13](https://library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=193)
- The gut includes complexity beyond the epithelial lining: nerves, muscles, immune system, luminal bacteria recognition, and microbiota. — Michael Helmrath (clinical) [Ep 3 · 0:55](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=55)
- The first bowel made roughly 11 years ago was small bowel, which was able to be transplanted into the animal. — Michael Helmrath (clinical) [Ep 3 · 1:25](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=85)
- Colon transplants into animals but not as well as small bowel, while antral structures (esophagus and stomach) did not and do not readily transplant into the animal. — Michael Helmrath (clinical) [Ep 3 · 1:34](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=94)
- Nerves are not present in the grafts initially; they are just mesenchyme and endoderm, but nerves can be added by adding neurosphere to the dish when transplanting. — Michael Helmrath (clinical) [Ep 3 · 2:05](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=125)
- When nerves are present in grafts, they cause the ingrowth of human vasculature; cells in the graft that are endothelial progenitors are told what to do by nerves. — Michael Helmrath (clinical) [Ep 3 · 2:20](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=140)
- Nerve presence is important for tissue used for the esophagus. — Michael Helmrath (clinical) [Ep 3 · 2:31](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=151)
- Growing cells in a confined space to make a long tube resulted in nerves co-developing by progenitors within the typical HIO without adding neurospheres. — Michael Helmrath (clinical) [Ep 3 · 2:40](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=160)
- Peristalsis starts in the cells of Cajal and the mesenchyme, then is affected and modulated by the nerve. — Michael Helmrath (clinical) [Ep 3 · 3:26](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=206)
- The tissue demonstrates the ability to both contract and relax, which are important properties for building esophagus. — Michael Helmrath (clinical) [Ep 3 · 4:02](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=242)
- HIOs can be separated in a dish with the inside being epithelium/endoderm and the outside being mesenchyme, like an Oreo cookie, and can be recombined with any mesenchyme. — Michael Helmrath (clinical) [Ep 3 · 4:11](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=251)
- When separated and recombined, the mesenchyme and endoderm remain fully faithful to their original identity. — Michael Helmrath (clinical) [Ep 3 · 4:29](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=269)
- A rat model was developed by dividing the bowel and damaging it with hot EDTA and a brush, then placing HIO fragments inside the lumen. — Michael Helmrath (clinical) [Ep 3 · 4:58](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=298)
- At 7 days after fragment placement, IPS-generated fragments show both epithelial engraftment (staining brown for human KU 80) and mesenchymal engraftment, while control somatic stem cells rarely show engraftment. — Michael Helmrath (clinical) [Ep 3 · 5:22](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=322)
- Cincinnati Children's was awarded Organoid Cure funding to put together data to grow human intestine to put into a patient and obtain FDA approval. — Michael Helmrath (clinical) [Ep 3 · 6:14](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=374)
- Working with Georgia Tech, the team developed a hydrogel that when exposed to UV light polymerizes like glue and holds tissue in place without killing cells, allowing cells to migrate out. — Michael Helmrath (clinical) [Ep 3 · 6:50](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=410)
- The first step is tissue agnostic, with intestinal transplant serving as a tool to gather information. — Michael Helmrath (opinion) [Ep 3 · 7:21](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=441)
- Diseases like esophageal strictures are very applicable to this therapy. — Michael Helmrath (opinion) [Ep 3 · 7:31](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=451)
- Dr. Helmrath anticipates using this therapy within the current decade in patients. — Michael Helmrath (opinion) [Ep 3 · 7:31](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=451)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Children with oesophageal atresia usually have their esophagus surgically repaired shortly after birth. — The host summarizing a resource [Ep 1 · 0:01](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=1)
- After surgical repair of esophageal atresia, it is common for children to develop an abnormal narrowing (stricture or stenosis) in the esophagus at the anastomosis point where the two halves were joined. — The host summarizing a resource [Ep 1 · 0:30](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=30)
- Esophageal strictures prevent the normal passage of food to the stomach. — The host summarizing a resource [Ep 1 · 1:00](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=60)
- Children with esophageal strictures may take longer to eat than usual and may show breathing difficulties whilst drinking. — The host summarizing a resource [Ep 1 · 1:10](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=70)
- Signs of esophageal stricture may only become apparent when children start eating solid foods at a later age, with solid foods becoming stuck in the esophagus leading to discomfort and difficulty swallowing. — The host summarizing a resource [Ep 1 · 1:25](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=85)
- All patients born with oesophageal atresia should be treated at a specialist center with a multidisciplinary team. — The host summarizing a resource [Ep 1 · 2:00](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=120)
- Depending on symptom severity and the child's previous history, the clinical team may obtain X-ray images of the esophagus to examine the stricture using a contrast study where a tube is passed through the nose into the esophagus and special fluid is injected and observed on X-ray. — The host summarizing a resource [Ep 1 · 2:10](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=130)
- Contrast X-ray studies show the tightness of the stricture and how easily fluid passes through it. — The host summarizing a resource [Ep 1 · 2:25](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=145)
- If there is a significant stenosis, esophageal dilation is needed to widen the narrowed area so that food can more freely pass into the stomach. — The host summarizing a resource [Ep 1 · 2:30](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=150)
- Esophageal dilation is always done under general anesthesia. — The host summarizing a resource [Ep 1 · 2:40](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=160)
- In most cases of esophageal dilation, an endoscope is used to insert a small balloon inside the stricture, which inflates to stretch open the stricture and is then removed. — The host summarizing a resource [Ep 1 · 2:45](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=165)
- Another esophageal dilation method uses the endoscope to pass a tapered elastic tube called a bougie into the esophagus to the stricture, with the doctor using several tubes one after the other that get progressively wider to gradually stretch the stricture. — The host summarizing a resource [Ep 1 · 3:00](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=180)
- After esophageal dilation, oral feeding can restart under clinical team observation, which might be required for a few hours or sometimes the child will need to stay in the hospital overnight. — The host summarizing a resource [Ep 1 · 3:15](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=195)
- A stricture can reoccur after a dilation procedure, and often the same procedure is needed multiple times before the esophagus is wide enough to pass food through it sufficiently. — The host summarizing a resource [Ep 1 · 3:25](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=205)
- Most cases of esophageal stricture can be managed with 1, 2, or 3 dilation procedures. — The host summarizing a resource [Ep 1 · 3:30](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=210)
- In rare cases of esophageal stricture, other additional treatments beyond dilation may be needed. — The host summarizing a resource [Ep 1 · 3:32](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=212)
- Follow-up support for oesophageal atresia should be both lifelong and structured. — The host summarizing a resource [Ep 1 · 3:33](https://library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=213)
- The lab has developed methods to grow from a single stem cell drawn from blood the entire GI tract from mouth to anus. — Em Gootee summarizes what Dr. Michael Helmrath said [Ep 3 · 1:16](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=76)
- A single organoid grown in a dish for roughly a month and transplanted into an animal produces human intestine on top of the kidney of the mouse that is fully laminated and looks no different than a biopsy. — Em Gootee summarizes what Dr. Michael Helmrath said [Ep 3 · 1:45](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=105)
- Nerves formed in confined space growth are much better compared to when added externally and are very similar to human controls. — Em Gootee summarizes what Dr. Michael Helmrath said [Ep 3 · 3:15](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=195)
- Grafts can be externally stimulated and nerve function can be blocked with TTX, and relaxation can be blocked by L-NAME. — Em Gootee summarizes what Dr. Michael Helmrath said [Ep 3 · 3:36](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=216)
- L-NAME hydrochloride can be used in animal modeling to construct cardiovascular and cerebrovascular disease models and has been widely applied for several decades as an antagonist of nitric oxide synthase. — Em Gootee summarizes what Dr. Michael Helmrath said [Ep 3 · 3:47](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=227)
- The mesenchyme from HIO can be combined with other endoderms to create different tissue types including colon. — Em Gootee summarizes what Dr. Michael Helmrath said [Ep 3 · 4:44](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=284)
- The cells migrate in a non-confined space such that at 10 weeks the whole epithelium is human, with muscle cells aligned with existing rat cells and fully functional. — Em Gootee summarizes what Dr. Michael Helmrath said [Ep 3 · 5:40](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=340)
- A custom accelerator space is dedicated to translating the team's work with world-class scientists. — Em Gootee summarizes what Dr. Michael Helmrath said [Ep 3 · 6:29](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=389)
- The hydrogel delivery method could be used for recalcitrant strictures by dilating, spraying cells, and applying UV light to keep cells localized. — Em Gootee summarizes what Dr. Michael Helmrath said [Ep 3 · 6:59](https://library.globalcastmd.com/watch/growing-functional-intestinal-tissue-from-stem-cells-with-dr-michael-helmrath-16523?t=419)

## Changelog
- Nov 3: 3 items added automatically

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