WOFAPS 2025 8th World Congress of Pediatric Surgery

Aiman Khan, Syed Waqas Ali, Muhammad Arif Mateen Khan

Department of Pediatric Surgery, Dow University of Health Sciences / Dr Ruth KM Pfau Civil Hospital, Karachi, Sindh, Pakistan

Abstract

Background:
Esophageal stricture is a common and challenging complication following esophageal atresia (EA) repair, particularly in low-birth-weight premature neonates. Serial esophageal dilations are the primary treatment; however, refractory strictures often necessitate alternative management approaches.

Case Presentation:
We report the case of a 1.7 kg male neonate born at 33 weeks of gestation with type C EA and a significant gap between atretic segments. Post-surgical repair with tensioned anastomosis was complicated by prolonged ventilation due to pulmonary atelectasis and pneumonia. The infant developed a tight anastomotic stricture, requiring feeding gastrostomy and multiple esophageal dilations, which were hindered by recurrent infections and airway reactivity.

To manage the refractory stricture, a 4 cm fully covered biliary stent was endoscopically placed. Although initial symptom relief was achieved, the stent migrated distally, necessitating removal. Following stent removal, the patient progressively tolerated oral feeding and required only two additional dilations over the next year, ultimately thriving on a weaning diet.

Discussion:
The use of biliary stents in pediatric esophageal strictures offers a novel approach to address refractory cases, providing constant radial pressure to maintain luminal patency and minimize the need for repeated interventions. While commonly used in adults, their application in children remains limited due to the lack of pediatric-specific stents.

Conclusion:
This case highlights the successful use of a biliary stent as an alternative for refractory esophageal stricture in a neonate, demonstrating its potential to reduce the frequency of dilations and improve outcomes. Further research is warranted to establish standardized protocols and long-term efficacy of biliary stents in pediatric patients.