# Esophageal Stricture — GCMD Library living collection

Everything in the library about esophageal stricture — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 33 cited statements

## Episodes
### Surgical Management
- [Esophageal Dilation for children with Esophageal Atresia](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602) — video · 3:34 · [machine version](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602.md)

### Complications
- [Button Battery Ingestion](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300) — video · 14:28 · [machine version](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300.md)

### Evidence & Research
- [STEPS-EA trial: Esophageal Atresia](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606) — video · 3:19 · [machine version](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606.md)

## Chapters
- [0:01](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1) Case presentation and initial management of button battery ingestion (Ep 1)
- [2:33](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=153) Complications and follow-up management challenges (Ep 1)
- [4:41](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281) Epidemiology, pathophysiology, and vascular complications (Ep 1)
- [8:47](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527) Management of batteries in the stomach and esophageal injury (Ep 1)
- [13:09](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=789) Emerging treatments and summary (Ep 1)
- [0:01](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=1) Esophageal atresia repair and stricture formation (Ep 2)
- [1:15](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=75) Diagnostic imaging of esophageal strictures (Ep 2)
- [2:10](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=130) Esophageal dilation techniques (Ep 2)
- [3:00](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=180) Post-procedure management and follow-up (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=0) Introduction and Background on Esophageal Atresia Strictures (Ep 3)
- [1:00](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=60) Intervention Mechanism and Technique (Ep 3)
- [2:00](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=120) Study Design, Safety Monitoring, and Participation (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The standard treatment for esophageal atresia is surgery with an end to end anastomosis to restore continuity. — Anfleur von Hall (clinical) [Ep 3 · 1:00](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=60)
- Stricture formation remains the most frequent post-operative complication in more than half of the cases of esophageal atresia. — Anfleur von Hall (epidemiological) [Ep 3 · 1:15](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=75)
- The standard treatment for esophageal stricture is endoscopic dilatation either by bouginage or by balloon dilatation. — Anfleur von Hall (clinical) [Ep 3 · 1:25](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=85)
- Worldwide, the balloon is most frequently used for esophageal stricture dilatation. — Anfleur von Hall (epidemiological) [Ep 3 · 1:35](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=95)
- Intralesional steroid injections use triamcinolone (Kenalog) as the most common agent. — Anfleur von Hall (clinical) [Ep 3 · 1:50](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=110)
- Steroids inhibit the formation of collagen, enhance its breakdown, and decrease fibrotic healing in esophageal strictures. — Anfleur von Hall (clinical) [Ep 3 · 1:55](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=115)
- Each of the four quadrants of the esophageal stricture is injected with steroid in the STEPS-EA protocol. — Anfleur von Hall (clinical) [Ep 3 · 2:05](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=125)
- 110 children born with esophageal atresia are needed to prove the effectiveness of the steroid injection. — Anfleur von Hall (clinical) [Ep 3 · 2:25](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=145)
- Study Group A will be injected with triamcinolone and then undergo balloon dilatation, while Study Group B will only undergo balloon dilatation. — Anfleur von Hall (clinical) [Ep 3 · 2:32](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=152)
- A second esophagram will be performed to objectify the effectiveness of the intervention on the length and diameter of the stricture. — Anfleur von Hall (clinical) [Ep 3 · 2:50](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=170)
- Physical length and weight will be measured at 4 time points throughout the 6 month study period to investigate possible systemic side effects of steroid injection. — Anfleur von Hall (clinical) [Ep 3 · 3:00](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=180)
- A hair sample will be collected at the end of the follow-up period to measure cortisol levels to investigate possible systemic effects of intralesional steroid injection. — Anfleur von Hall (clinical) [Ep 3 · 3:10](https://qa.library.globalcastmd.com/watch/steps-ea-trial-esophageal-atresia-7606?t=190)
- Button battery ingestions are becoming more frequent, with national data suggesting increasing numbers of emergency department visits. — Dan (epidemiological) [Ep 1 · 0:01](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1)
- A radiographic ring around the edge of a circular object on X-ray indicates a button battery rather than a quarter. — Dan (clinical) [Ep 1 · 1:30](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=90)
- The Foley catheter technique may work for button battery removal in limited situations when the operating room cannot be accessed quickly and there is short duration of symptoms without likely perforation. — Dan (clinical) [Ep 1 · 2:10](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=130)
- NASPA and the GI group put together criteria and guidelines around management of button batteries with zero input from surgeons. — Mark (guideline) [Ep 1 · 3:44](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=224)
- The guidelines mandate multiple MRIs and watching these patients because of concern for vascular injury. — Mark (guideline) [Ep 1 · 4:05](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=245)
- The number of ED visits for button battery ingestion has doubled according to data from Colorado. — Dan (epidemiological) [Ep 1 · 4:41](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281)
- The rate of significant complications from button battery ingestion has increased almost sevenfold. — Dan (epidemiological) [Ep 1 · 4:55](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=295)
- 90% of serious outcomes from button battery ingestion occur with 20 millimeter to 25 millimeter batteries. — Dan (epidemiological) [Ep 1 · 5:05](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=305)
- The problematic batteries are lithium batteries that tend to be 3 volt batteries as opposed to 1.5 volt batteries. — Dan (clinical) [Ep 1 · 5:20](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=320)
- The pathophysiology of button battery injury is caustic injury from hydroxide ions that rapidly raise the pH in tissue, not erosion of the battery itself or electricity. — Dan (clinical) [Ep 1 · 5:35](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=335)
- Complications of button battery ingestion include esophageal perforation, stricture, tracheoesophageal fistula, vocal cord paralysis not associated with perforation, and aortoenteric fistula. — Dan (clinical) [Ep 1 · 6:00](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=360)
- Aortoenteric fistula is the most common cause of mortality in button battery ingestion, accounting for 46% of mortalities in the national data bank. — Dan (epidemiological) [Ep 1 · 6:30](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=390)
- Vascular compromise was identified as the etiology in another 29% of mortalities from button battery ingestion. — Dan (epidemiological) [Ep 1 · 6:50](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=410)
- Aortoenteric fistula from button battery ingestion can happen up to 2 weeks post removal of the battery. — Dan (clinical) [Ep 1 · 7:05](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=425)
- A trauma one activation system for button battery ingestions reduced time from hitting the door to hitting the OR from 1.5 hours to less than 30 minutes. (clinical) [Ep 1 · 8:47](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527)
- The recommendation to scope patients when the battery is in the stomach completely flies in the face of actual recommendations from poison.gov, which say you do not need to do that. — Mark (guideline) [Ep 1 · 9:28](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=568)
- For relatively minor mucosal injury from button battery, no intervention is needed and symptomatic follow-up is appropriate. — Dan (opinion) [Ep 1 · 10:24](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=624)
- For circumferential erosions that look bad from button battery injury, re-scoping to look for stricture formation is appropriate. — Dan (opinion) [Ep 1 · 10:43](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=643)
- If a patient becomes symptomatic after button battery removal, an esophagram should be done to see if they have narrowing or stricture. — Dan (clinical) [Ep 1 · 10:54](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=654)
- If performing endoscopy and capable of removing a battery from the stomach endoscopically, removal is advocated because you are already there. — Dan (opinion) [Ep 1 · 12:27](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=747)
- There is evolving work in animal models using 0.25% acetic acid applied to the area of injury to neutralize caustic damage from button batteries. (clinical) [Ep 1 · 13:34](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=814)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Children with esophageal atresia usually have their esophagus surgically repaired shortly after birth. — The host summarizing a resource [Ep 2 · 0:18](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=18)
- After surgical repair of esophageal atresia, it is common for children to develop an abnormal narrowing (stricture or stenosis) at the anastomosis site where the two halves were joined. — The host summarizing a resource [Ep 2 · 0:30](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=30)
- Esophageal strictures prevent normal passage of food to the stomach. — The host summarizing a resource [Ep 2 · 0:50](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=50)
- Children with esophageal strictures may take longer to eat than usual and may show breathing difficulties whilst drinking. — The host summarizing a resource [Ep 2 · 0:56](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=56)
- Signs of stricture may only become apparent when children start eating solid foods at a later age, with solid foods becoming stuck and causing discomfort and dysphagia. — The host summarizing a resource [Ep 2 · 1:06](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=66)
- All patients born with esophageal atresia should be treated at a specialist center with a multidisciplinary team. — The host summarizing a resource [Ep 2 · 1:22](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=82)
- Contrast esophagography for stricture evaluation involves passing a small tube through the nose into the esophagus above the narrowed part, injecting special fluid, and observing on X-ray to assess stricture tightness and fluid passage. — The host summarizing a resource [Ep 2 · 1:32](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=92)
- Esophageal dilation is always done under general anesthesia. — The host summarizing a resource [Ep 2 · 2:10](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=130)
- In most cases of esophageal dilation, an endoscope is used to insert a small balloon inside the stricture, which inflates to stretch open the stricture before being removed. — The host summarizing a resource [Ep 2 · 2:15](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=135)
- An alternative dilation technique uses the endoscope to pass a tapered elastic tube called a bougie into the esophagus to the stricture, with serial tubes of increasing diameter used to gradually stretch the stricture. — The host summarizing a resource [Ep 2 · 2:35](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=155)
- After esophageal dilation, oral feeding can restart under clinical observation, which might require a few hours or sometimes overnight hospital stay. — The host summarizing a resource [Ep 2 · 2:55](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=175)
- Strictures can recur after dilation and often the same procedure is needed multiple times before the esophagus is wide enough to pass food sufficiently. — The host summarizing a resource [Ep 2 · 3:08](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=188)
- Most cases of esophageal stricture can be managed with 1, 2, or 3 dilation procedures. — The host summarizing a resource [Ep 2 · 3:20](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=200)
- In rare cases, additional treatments beyond dilation may be needed for esophageal strictures. — The host summarizing a resource [Ep 2 · 3:26](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=206)
- Follow-up support for esophageal atresia should be both lifelong and structured. — The host summarizing a resource [Ep 2 · 3:30](https://qa.library.globalcastmd.com/watch/esophageal-dilation-for-children-with-esophageal-atresia-7602?t=210)
- Authors of a paper presenting 16 cases recommended getting an MRI study after removal of the battery to look at potential impact on surrounding vasculature. — Dan summarizing the discussion [Ep 1 · 7:25](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=445)
- Authors advocate that patients should be scoped even if the battery is in the stomach because patients had significant esophageal injuries despite the battery passing to the stomach. — Dan summarizing the discussion [Ep 1 · 8:47](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527)

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