ANOMALY

Esophageal
Atresia

CAUSE/MECHANISM
Failure of the primitive
foregut to recanalize

TE fistula

Newborns

Atresia + distal
TE fistula: most
common
H-type fistula

failure of the lung bud

to separate completely
from the foregut

Esophageal
stenosis

- incomplete
separation of lung bud
from primitive foregut
- fibromuscular
hypertrophy
associated with
damage to the
myenteric plexus
- epithelial-lined
outpouchings of the
primitive foregut
- evolve to produce
either cystic or tubular
structures that do not
communicate with the
esophageal lumen
- Compression of
esophagus by aberrant
right subclavian artery
- artery arises from
the left side of the
aortic arch

Esophageal
duplications
a. Cysts: 80%
b. Tubular
structure
Arteria lusoria

CONGENITAL ANOMALIES OF THE ESOPHAGUS

PREDOMINANT
AGE AT PRESENTATION
SYMPTOMS
Newborns
- Regurgitation of
feedings
- Aspiration
- Regurgitation of
feedings
- Aspiration

DIAGNOSIS
- Esophagogram
- AXR: gasless abdomen
- confirmed by failure to
pass an NGT into the
stomach
- Esophagogram
- AXR: gas-filled
abdomen

TREATMENT
Surgery

Surgery
Childhood or adulthood
Infants to adults

Recurrent pneumonia
bronchiectasis
dysphagia
food impaction

Infants to adults

- Infants: Dyspnea,
stridor, cough
- Adults: dysphagia,
chest pain

Children to adults

Dysphagia lusoria

- Esophagogram
- bronchoscopy
- Esophagogram:
abrupt or tapered
stricture
- Confirmation:
endoscopy
- EUS
- EUS:
*Anechoic: benign
duplication cysts
* Hypoechoic lesions:
FNAB to exclude
malignancy
- MRI/CT
- Barium
esophagogram: pencillike indentation at the
level of the T3 or T4
vertebrae
- EGD: right radial pulse
may diminish or
disappear from

Dilatation (endoscopicguided bougienage)

Surgery

- Simple modification
of the diet to meals of
soft consistency and
small size
- Surgery

instrumental
compression of the right
subclavian artery
- Esophageal
manometry: highpressure zone at the
location of the aberrant
artery
Esophageal rings
A (rare)
- 4 to 5 mm
- squamous
symmetrical band of
epithelium
hypertrophied muscle
- constricts the tubular
esophageal lumen at
its junction with the
vestibule
B/Schatzki
- always in association
more common
with a hiatal hernia
- recognized as a thin
- upper surface: membrane that
squamous
constricts the
epithelium
esophageal lumen at
the junction of the
- lower surface:
vestibule and gastric
columnar
cardia
epithelium
Esophageal
webs
- common in
cervical
esophagus
- PlummerVinson or
Paterson-Kelly
syndrome:
webs+ IDA+
dysphagia
Heterotropic

Children to adults

Generally asymptomatic
Occasionally: dysphagia
to solids and liquids

Esophagogram
Endoscopy

- Generally asymptomatic
- if lumen <13 mm:
intermittent dysphagia
for solids or unheralded
acute solid-food
impactions

one or more thin

horizontal membranes
of stratified squamous
epithelium within the
upper esophagus and
midesophagus

Children to adults

- Dysphagia for solids

- may be asymptomatic

Esophagogram
Endoscopy

a small (0.5 to 2 cm)

Children to adults

asymptomatic

- Biopsy: antral or

- passage of a 50French mercuryweighted esophageal

dilator
- injection of
botulinum toxin
- Asymptomatic: no
treatment
- Symptomatic:
a. passage of a single,
large (50-French),
mercury-weighted
dilator, or
b. series of such
dilators of
progressively larger
diameter
Bougienage

No treatment

Gastric
mucosa
(inlet patch)

distinctive, velvety red

island of heterotopic
gastric mucosa amid a
lighter pink squamous
mucosa

fundic type of mucosa

- may be infected with
Helicobacter pylori