High-frequency miniprobes and 3-dimensional EUS for preoperative evaluation of the etiology of congenital esophageal stenosis in children (with video).

Esophageal stenosis in children is most commonly acquired (95%) but can be congenital (5%) as well.1 Congenital esophageal stenosis (CES) is a rare condition thought to occur in 1 per 25,000 to 50,000 live births.2 The malformations that cause the stenosis can be divided into 3 categories: tracheobronchial remnants (TBRs), a membranous diaphragm, and fibromuscular stenosis.3 A preoperative diagnosis is very difficult to make because TBRs are not visible on a CT scan or magnetic resonance imaging, and the ideal therapeutic strategy remains controversial.4 CES is commonly managed initially with Savary-Gilliard dilation or hydrostatic balloon dilation, whereas resection with anastomosis is needed in intractable cases such as fibromuscular hypertrophy and those patients with tracheobronchial rests. Most intractable cases are caused by the presence of tracheobronchial rests; in these patients, endoscopic dilation attempts could lead to perforation.5 We describe 3 pediatric patients in whom a preoperative diagnosis of CES caused by ectopic TBRs was made by using high-frequency 3-dimensional (3D) catheter probe EUS. Based on our results and a review of cases described in literature, we propose that probe EUS and 3D EUS should be included in the diagnostic workup of CES before endoscopic dilation is performed.