SUBJECT: SUBMISSION OF THE MANUSCRIPT TITLED “MANAGEMENT OF REFRACTORY ANASTOMOTIC STRICTURES FOLLOWING ESOPHAGEAL ATRESIA REPAIR. LITERATURE REVIEW

Abstract

Background: Refractory anastomotic strictures (AS) following esophageal atresia (EA) repair in children remain a challenging clinical issue, often resistant to standard endoscopic balloon dilatation (EBD). Despite multiple sessions, some patients experience persistent or recurrent symptoms, potentially associated with excessive fibrosis during healing process. Objective: To evaluate novel, less invasive, and potentially more effective treatment strategies for managing refractory anastomotic strictures after esophageal atresia repair in pediatric patients.. Search strategy: A literature review was conducted using the Web of Science and PubMed databases, covering a 5-year period. The treatment modalities for refractory esophageal anastomotic strictures were categorized into seven groups: (1) intralesional corticosteroid injection (ICI), (2) systemic corticosteroid therapy, (3) topical application of mitomycin C (MMC), (4) endoscopic incisional therapy (EIT), (5) esophageal stenting, (6) cell-based therapies, and (7) magnetic recanalization. Results: Contemporary treatment options for pediatric refractory esophageal strictures were analyzed. Intralesional corticosteroid injections, particularly triamcinolone, have been associated with reduced dilation frequency in short strictures, though potential complications include adrenal suppression and infectious risks. MMC has shown variable efficacy; some studies reported a reduction in stricture frequency, while others found no significant benefit. EIT has proven effective for short, asymmetric strictures but carries a high risk of esophageal perforation. Both esophageal stenting and systemic corticosteroid therapy remain controversial due to limited supporting evidence. Emerging techniques, including magnetic recanalization and cell-based therapies using autologous grafts or extracellular matrix scaffolds, are still in experimental stages but have shown promising outcomes in select cases. Conclusion: There is no universally accepted treatment for refractory esophageal strictures. Intralesional corticosteroids and mitomycin C appear promising for short strictures, while novel therapies require further investigation. Prospective, comparative studies involving larger cohorts and long-term follow-up are essential to determine optimal treatment strategies, establish objective efficacy criteria, and confirm the safety of new therapeutic approaches.