Tokushukai Medical Group

Treatment of disorder

medical treatment

Pediatric Diseases: Congenital Atresia of the Esophagus

Surgery connecting upper and lower esophagus is necessary.

The disease is, by nature, esophagus ends in the middle, and appears at the rate of one out of 5,000 person. Baby is unable to drink milk. Most of the case there is a connection between esophagus and throat, and as shown at below figure, this disease is grouped into 5 types, from A type to E type.

Gross Separation A type B type C type D type E type
Japan (Tsunoda)
1,097 cases
USA (Holder)
1,058 cases

Fig. Classification of congenital Atresia of the Esophagus

The most common one is type C which bottom of esophagus connected to throat, and this type is over 80%. Type A which has no connection with throat takes roughly 20%, and because the span between upper and lower esophagus is long enough, treatment for this type may take often longer period. Type B and D and E are very rare case.

Surgery is necessary for all types. Basic surgery method is to close throat and fistula and connect upper and lower esophagus. But when span between upper and lower esophagus is long, it is unlikely connect them at once, so that firstly making a hole on stomach and insert a tube in it, then feed milk from there. After that surgery is conducted in several batches in adding several supplemental surgeries.

Pay attention for the complication with tracheomalacia or gastroesophageal reflux disease.

Regarding the complicating disease after surgery, there are, connection of esophagus is failed (failure of the sutures), fistula opens again between throat and esophagus, or connected point is getting narrower (arctation). In case of arctation, narrower part can be expanded using balloon, and the most of failure of the sutures can be conservatively cured, but in regard to re-opened fistula, re-operative surgery is necessary. Further, the complicating disease occur a little later the surgery are; tracheomalacia, which throat gets crushed when breathe since throat is getting weak, and gastroesophageal reflux disease, which gastric acid flow adversary from stomach to throat. There is a tracheomalacia which is cured by follow-up only, but there is also a case where surgery becomes necessary. In regard to gastroesophageal reflux disease, there is a one which is cured by oral medicine only, but in case of severe one, surgery to prevent reverse flow of gastric acid.

For congenital atresia of esophagus disease, in the past, tremendous effort was necessary to save life, but due to the progress in full anesthesia, 65% of them become saved its life. 15% of the rest, almost all of them are complicated with severe cardiac large artery abnormality, so that they are passed away because of this cardiac disease.