Endoscopic management for congenital esophagealstenosis： A systematic review

Congenital esophageal stenosis （CES） is an extremelyrare malformation, and standard treatment havenot been completely established. By years of clinicalresearch, evidence has been accumulated. Weconducted systematic review to assess outcomes ofthe treatment for CES, especially the role of endoscopicmodalities. A total of 144 literatures were screenedand reviewed. CES was categorized in fibromuscularthickening, tracheobronchial remnants （TBR） andmembranous web, and the frequency was 54%,30% and 16%, respectively. Therapeutic optionincludes surgery and dilatation, and surgery tendsto be reserved for ineffective dilatation. An essentialpoint is that dilatation for TBR type of CES has lowsuccess rate and high rate of perforation. TBR can bedistinguished by using endoscopic ultrasonography（EUS）. Overall success rate of dilatation for CES withor without case selection by using EUS was 90% and29%, respectively. Overall rate of perforation with orwithout case selection was 7% and 24%, respectively.By case selection using EUS, high success rate with lowrate of perforation could be achieved. In conclusion,endoscopic dilatation has been established as a primarytherapy for CES except TBR type. Repetitive dilatationwith gradual step-up might be one of safe ways tominimize the risk of perforation.