Surgical treatment of esophageal stricture secondary to gastroesophageal reflux

Of 180 patients, 115 evaluated for gastroesophageal reflux (GER) over a 4-yr period were found to be positive. Fourteen patients, ages 3 mo to 15 yr, presented with symptoms of esophageal stricture. Seven patients had a history of previous repair of esophageal atresia (EA). GER was diagnosed variously by barium swallow, radionuclide gastroesophagography, acid reflux test, and endoscopy with biopsy. The stricture may have acted as a barrier and altered the diagnosis of GER higher in the esophagus. Esophageal manometric were performed in 11 of the 14, and were uniformly abnormal. When the diagnosis of persistent esophageal stricture in association with GER was apparent, intraoperative esophageal dilatation and antireflux surgery with intraoperative manometrics were carried out in 13 patients. There was no operative mortality. In 10 of the 13 patients clinical resolution of the stricture was confirmed by barium swallow or esophagoscopy. The remaining 3 patients with stable dense fibrous strictures from long-standing GER, still requie dilatations. Stricture resolution occurred in 9 patients without the need for postoperative dilatations, including 5 with previously repaired EA. There was 1 esophageal perforation and 1 disrupted fundoplication, both of which responded to surgery. Esophageal stricture may be a result of insidious GER. Early diagnosis and surgical correction of GER, aided by esophageal manometrics, will result in healing of esophagitis and rapid resolution of strictures in the majority of patients. Long-standing strictures may require persistent dilatation. Esophageal resection and substitution should be required infrequently.