Question A 4-month-old Girl with Esophageal stenosis, Case discussion.

[Mahmoud Kaddah]

A 4-month-old baby girl with a history of chronic cough and difficulty feeding and regurgitation was referred to our hospital because she was diagnosed with esophageal stenosis after performing a contrast swallow.
the baby weighs 4 kgs and does not seem malnuritied

flexible fiber-optic bronchoscopy and Upper GI endoscopy were done at the same anesthesia.

• bronchoscopy was normal
• upper gi endoscopy showed esophageal stenosis 13cm from the tooth arch. no hiatal hernia or signs of esophageal inflammation were detected.

the stenosis appeared to be because an external compression, so a contrast-enhanced chest CT was performed to exclude external compression by a foregut cyst or vascular ring.

looking for opinions about management.

[Mahmoud Kaddah]

[Mahmoud Kaddah]

[Secundino López Ibarra]

if there is no evidence of reflux, it is a congenital stenosis. It is necessary to see if the stenosis is punctate or not and the length. Based on this, dilate it vs resection and anastomosis.
I would do this last option

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[Mahmoud Kaddah]

There is no signs of reflux of esophagitis, i can post the Full Video of upper endoscopy .

[Ahmed Nabil]

Can you post contrast study?

after exclusion of vascular ring/external mass, Is Endoscopic ultrasound (EUS) available?. EUS verifying cartilaginous remnants in esophagus can predict a poor response to endoscopic dilatation vs cases of fibro-muscular dysplasia

[Mahmoud Kaddah]

I will try to post the upper contrast study .
EUS is not available here in Syria

[Mahmoud Kaddah]

flexible bronchoscopy and Upper gi endoscopy good resolution

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Achalasia?

[Ahmed Nabil]

flexible bronchoscopy and Upper gi endoscopy good resolution

may be Schatzki ring ?

Upper GI study will be helpful and can be repeated if the outside study is not of good quality.

[Mahmoud Kaddah]

This patients Was diagnosed with Achalasia and Surgery was done.
She is now doing well after Surgery.

[Ahmed Nabil]

This patients Was diagnosed with Achalasia and Surgery was done.
She is now doing well after Surgery.

thank you for update!
I have a question, did you do manometry for diagnosis of achalasia ? what was the manometric findings ?
also operative photos are appreciated.