Use of high-resolution endoscopic ultrasonography to examine the effect of tension on the esophagus during primary repair of long-gap esophageal atresia

We have shown that tension applied to the esophageal pouches in long-gap esophageal atresia allows primary repair without necessity for intestinal or gastric transposition. To determine whether the mural structure of the upper esophageal pouch is altered by tension. We examined the esophagus with high-resolution endoscopic ultrasonography. The upper pouch was examined before traction and the upper and lower esophagus were examined after primary repair. Of 11 patients examined, 7 were male. At initial surgery the age, weight and length of the patients (mean +/- SD) were 118 +/- 88 days, 4.7 +/- 1.2 kg and 54 +/- 4 cm, respectively. The gap length was 4.7 +/- 1.1 cm. The pretraction measurement of the muscularis propria of the upper pouch was similar to the postanastomotic measurement of the upper esophagus, and there was no statistically significant difference from the lower esophageal segments after anastomosis: 0.83 +/- 0.19, 0.80 +/- 0.15 and 0.81 +/- 0.22 mm, respectively (P = 0.90). The thickness of combined mucosa and submucosa was also very similar in all three measurements, respectively: 0.93 (0.21) mm vs. 1.06 (0.08) mm vs. 1.0 (0.11) mm (P = 0.14). The layers of the upper esophageal pouch are preserved in infants with esophageal atresia in whom esophageal length is increased with tension.