Esophageal Dilation for children with Esophageal Atresia

This animation aims to provide you with more information about a treatment called esophageal dilation for children with oesophageal atresia. Usually shortly after birth, children with oesophageal atresia have their esophagus surgically repaired. After surgical repair, it is common for children to develop an abnormal narrowing in the esophagus at the point where the two halves were joined by the surgeon. This is called a stricture, or it can also be called a stenosis. This narrowed part of the esophagus prevents the normal passage of food to the stomach. If your child develops a stricture, they may take longer to eat than usual. They may also show breathing difficulties whilst drinking. Signs may only be apparent when children start eating solid foods at a later age. Solid foods may become stuck in the esophagus, leading to discomfort and difficulty swallowing. It is important to discuss any symptoms and changes with your child's clinical team, as they could be a sign of a stricture or something else. All patients born with oesophageal atresia should be treated at a specialist center with a multidisciplinary team, which is a team of different clinical professionals. Depending on the severity of the symptoms and the child's previous history, the clinical team may want to take some X-ray images of your child's esophagus to examine the stricture. A small tube is passed through the nose and into the esophagus above the narrowed part. A special fluid is injected and observed on the X-ray. This shows the tightness of the stricture and how easily fluid passes through it. If there is a significant stenosis, a procedure called an esophageal dilation is needed to widen the narrowed area so that food can more freely pass into the stomach. This is always done under general anesthesia. There are two different ways that esophageal dilation can be done. In most cases, an endoscope is used to insert a small balloon inside the stricture. An endoscope is a long flexible tube with a camera that is passed through the mouth into the esophagus. The balloon inflates to stretch open the stricture, and then the balloon is removed. Another way is to use the endoscope to pass a tapered elastic tube called a bougie into the esophagus to the stricture. During the dilation procedure, the doctor will use several tubes, one after the other, and the tubes get wider each time. This gradually stretches the stricture. After the esophageal dilation, oral feeding can restart under the observation of the child's clinical team. This clinical observation might be required for a few hours or sometimes the child will need to stay in the hospital overnight. 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. Most cases can be managed with 12 or 3 dilation procedures. In rare cases, other additional treatments may be needed. Follow-up support for oesophageal atresia should be both lifelong and structured. Peer support can be accessed through patient and family support groups.