Comprehensive treatment for esophageal atresia and other pediatric esophageal disorders
The Esophageal Disorders program at C.S. Mott Children’s Hospital provides advanced care for infants and children with complex esophageal and airway problems, including:
- Esophageal atresia (EA), including long-gap esophageal atresia
- Tracheoesophageal fistulas (TEF), including recurrent TEF
- Esophageal duplications
- Esophageal strictures (narrowing of the esophagus)
- Hiatal hernia
Our multidisciplinary program offers expertise in treating the full range of esophageal disorders with innovative, evidence-based treatment plans designed to meet each individual child’s needs.
In 1941, we made history when Dr. Cameron Haight, a U-M thoracic surgeon, performed the world’s first successful esophageal atresia repair on an infant. Our surgical team uses the latest minimally invasive techniques and draws on the expertise of world renowned surgeon Dr. Arnold Coran, a U-M Emeritus Professor who has one of the world’s most extensive experience with complex esophageal disorders repair. Today, patients from all over the United States travel to C.S. Mott Children’s Hospital for esophageal surgery.
What is esophageal atresia?
Esophageal atresia (EA) is an abnormality of the esophagus that occurs early on during fetal development. The esophagus forms during the first few months of pregnancy as a long continuous tube connecting the mouth to the stomach. When the formation of this tube is interrupted, the result is a disconnect between the upper and the lower portions of the esophagus, with a pouch often forming on either side of the gap. In the case of long-gap esophageal atresia, the disconnect between the upper and lower tubes is at least several centimeters in length. Newborns with long-gap EA cannot eat by mouth. In addition, saliva can accumulate in the upper pouch since it cannot drain into the stomach, causing the child to choke.
Newborns with esophageal atresia often have an associated tracheosophageal fistula, which is an abnormal connection of the esophagus directly to the windpipe (trachea). Another abnormality that can occur alongside these abnormalities is tracheomalacia, in which the trachea is floppier than normal, and therefore collapses each time a child takes a breath.
While these disorders are sometimes detected during prenatal ultrasound exams, a definitive diagnosis is usually made after the baby is born. Delivery at or transfer to a major children’s medical center specializing in pediatric esophageal disorders is essential, in order to ensure an accurate and complete diagnosis as well as access to a comprehensive range of treatment alternatives.
How are esophageal disorders treated?
Esophageal disorders are rare and complex conditions. Each child’s treatment process will vary depending on the individual diagnosis, severity, and other medical criteria. It is important to choose a program experienced with not just one or two surgical repair techniques, but with the full range of treatment options to ensure your child has access to the appropriate therapies and repair methods for his or her needs.
C.S. Mott Children’s Hospital offers the full spectrum of treatments for esophageal disorders, including:
- primary repair of esophageal atresia, with 90% of cases using a patient’s own esophagus
- the Foker technique (esophageal traction) to allow for delayed primary repair of esophageal atresia
- peroral endoscopic myotomy (POEM), a minimally invasive option to treat esophageal achalasia
- tracheoesophageal fistula repair
- segmental esophageal resection
- gastric pull-up (also known as gastric transposition)
- colon interposition
- minimally invasive and robotic surgery
Thanks to our experienced surgical team, we are able to perform esophageal repairs on even the tiniest infants. In addition, we specialize in procedures for patients whose previous esophageal operations have failed to produce successful results.
Mott is one of few centers in the country to offer the minimally invasive peroral endoscopic myotomy (POEM) procedure to treat esophageal achalasia in pediatric patients, particularly older children and teens.
Depending on the severity of the diagnosis and your child’s individual needs, your child’s treatment could take anywhere from a month to several months to complete. Whenever possible, our focus is on surgical techniques that utilize your child’s own esophageal tissue (primary repair), rather than surgically transplanting tissue from other parts of the digestive system.
In cases where the child may not be a good candidate for primary repair, such as if primary repair requires multiple invasive procedures and/or prolonged hospitalization while the child’s esophageal tissue grows, we also offer expertise in pediatric esophageal replacement. We have performed or advised on nearly 200 esophagus replacement procedures, more than any other program in the U.S.
Our dedicated pediatric intensive care and surgical critical care teams provide specialized care for your child during this time, in which they will be monitored closely in our newborn intensive care unit.
In addition to your pediatric surgeon, your child’s care at U-M may involve specialists from otolaryngology, pulmonology, gastroenterology, and occupational therapy. Together, the team will develop an individualized treatment plan for your child, drawing on our expertise in the full range of treatment options available for esophageal disorders.
Many of our patients are followed long-term in our newly established aerodigestive clinic, an innovative multidisciplinary clinic designed to help your child lead a normal life following surgery. Babies born with esophageal disorders are at an increased risk of gastroesophageal reflux, respiratory difficulties, and developmental delays. Your child may require occupational therapy for swallowing difficulties and nutritional therapy for feeding problems that may develop. Your surgical team will continue to monitor your child closely for additional complications and will work with you to coordinate any long-term care or therapy that is needed.
Esophageal Patient & Family Support
Our team will work to coordinate your care from diagnosis through treatment and follow-up care. Our dedicated child life specialists and social work team also meet with each family to provide support and assistance throughout your child’s hospitalization and treatment.
We provide each family access to educational resources as well as emotional and practical support to aid in the daily care of their child after they return home from the hospital.
Many families travel great distances for esophageal treatment from our pediatric surgeons. For your convenience, our team will work with you to coordinate any diagnostic exams and follow-up appointments. Please refer to our Patient & Visitor Guide for more information on getting here, overnight accommodations, and interpreter assistance.
Why choose C.S. Mott Children’s Hospital for the treatment of esophageal disorders?
The most important criteria for choosing an esophageal disorders program is to select a team that can offer deep experience with the full range of treatment options. Although pediatric esophageal disorders like long-gap esophageal atresia are incredibly rare, the surgeons at the University of Michigan C.S. Mott Children’s Hospital understand the complexities and nuances of pediatric esophageal surgery. We recognize that no single procedure is appropriate for every child, and we offer a unique level of experience with multiple treatment options.
For more information or to make an appointment:
Call 1-877-475-6688 (1-877-475-MOTT)