Pediatr Gastroenterol Hepatol Nutr.  2012 Mar;15(1):52-56.

Preoperative Diagnosis of Congenital Esophageal Stenosis Caused by Tracheobronchial Remnants Using Miniprobe Endoscopic Ultrasonography in a Child

• Lee KS

Abstract

Congenital esophageal stenosis (CES) can be classified into three types based on the etiology of stenosis: tracheobronchial remnants (TBRs), fibromuscular hypertrophy (FMH), and membranous diaphragm (MD). It is important to make a differential diagnosis because the therapeutic plan for CES is determined by its etiology. Most cases of FMH and MD can be managed with balloon dilatation, whereas cases of TBRs require resection and anastomosis. Thus, the preoperative distinction of TBRs is critical. Recently miniprobe endoscopic ultrasonography (EUS) with a maximum diameter of 2.5 mm has been useful for distinguishing TBRs from FMH in pediatric patients with CES. EUS shows hyperechoic lesions indicating TBR cartilage. Miniprobe EUS is recommended for choosing the correct therapeutic method for CES. We report a case of CES due to TBRs in which a preoperative diagnosis was made in a child using miniprobe EUS without any difficulties.

Keyword

Congenital esophageal stenosis; Endoscopic ultrasonography; Child

MeSH Terms

Cartilage
Child
Diagnosis, Differential
Diaphragm
Dilatation
Endosonography
Esophageal Stenosis
Humans
Hypertrophy

Figure

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  Fig. 1 Esophageal endoscopy shows a stenotic central lumen at 30 cm distal esophagus from the incisor.

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  Fig. 2 Esophagography shows a luminal narrowing (arrow) of the distal esophagus with multiple extraluminal filling of barium and dilatation of the proximal esophagus.

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  Fig. 3 Endoscopic ultrasonography shows multiple hyperechogenic spots (arrows) spread into muscle layer of a stenotic lesion.

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  Fig. 4 Histologic picture of the resected specimen shows bronchial cartilage (blue arrow), mucus glands (yellow arrow), and ciliated respiratory epithelium (black arrow) in the esophageal wall (hematoxylin and eosin, ×40).

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