Congenital esophageal stenosis related to tracheobronchial remnant: balloon dilatation versus resection and anastomosis - a systematic review

Introduction: Congenital esophageal stenosis (CES) related to tracheobronchial remnant (TBR) is an extremely rare malformation, typically diagnosed in infants and young children.Endoscopic dilatation or resection and anastomosis are both accepted therapeutic options, but the superiority of one versus the other remains controversial.Methods: We performed a comprehensive literature search in PubMed and MEDLINE using standardized search terms and subject headings from 1969 onwards.Inclusion criteria were patient age 0 to 18 years, confirmed diagnosis of CES due to TBR, English language, intervention by balloon dilatation or surgical resection, and reporting of outcome.Results: A total of 215 articles were identified, of which 33 met the inclusion criteria.These consisted of 11 retrospective observational studies, 10 case series, and 12 single case reports.In total, 183 patients were included in our analysis, of which 103 patients were initially treated with resection/anastomosis, and 80 with primary dilatation.Patients who underwent primary resection required between 1 and 3 additional dilations.Patients who underwent initial dilatation required between 1 and 7 re-dilations.The resection/anastomosis group group demonstrated a significantly lower mean complication rate (2%) compared to those who underwent primary dilatation (13.8%, p<0.01). Conclusion:Both resection and balloon dilatation are viable options to treat CES associated with TBR.While those undergoing upfront dilatation are more likely to require further interventions, some may be spared a more invasive operative procedure.