Esophageal Atresia | Diagnosis & Treatment

How is esophageal atresia diagnosed?

Esophageal atresia (EA) is usually diagnosed shortly after birth when an infant exhibits symptoms such as coughing, choking and turning blue when trying to feed. If the physician is unable to pass a feeding tube all the way into the child's stomach through the nose or mouth, this is a sign of EA. This diagnosis is then typically confirmed with x-rays.

Sometimes, EA is identified before birth if the mother's ultrasound shows too much amniotic fluid or an "absent stomach," which is a sign of this disorder.

How is esophageal atresia treated?

Multiple surgical treatments are available for children with EA, EA/TEF or long-gap EA. Boston Children's offers expertise in innovative approaches to esophageal growth and repair. Your child's treatment plan may include one or more of the following procedures:

The Foker process. This groundbreaking technique stimulates the upper and lower ends of the esophagus to make them grow inside your baby, allowing them to then be joined together after several days or weeks. Boston Children's is the only pediatric hospital that routinely offers the Foker process to treat long gap EA.

The minimally invasive Foker process. For some children, a new minimally invasive version of the Foker process may be an option. As its name implies, the minimally invasive Foker process involves very small incisions on your child’s back and uses minimally invasive instruments and a camera. The surgeon places traction sutures on each end of the esophagus but creates the traction system inside your child’s body by securing the sutures around one of their ribs. Surgeons tighten these sutures every week until the two ends of the esophagus are close enough to attach to each other.

Watch our video series to learn more.  

What is the Foker process?

What is the minimally invasive Foker process?

Static internal traction. Your baby may benefit from this procedure, which provides some esophageal growth and can shorten the time your baby must spend under anesthesia.

Dynamic internal traction. This is another method of growing the esophagus that may be applicable in some situations to shorten the time your baby must spend under anesthesia.

Primary anastomosis. This surgical procedure connects the esophageal gap. Our surgeons have treated hundreds of children with EA, giving them the experience and expertise necessary to successfully connect the esophagus in the first operation.

Jejunal interposition. If the Foker process isn't right for your child, jejunal interposition may be an option. Our surgeons have perfected this sophisticated technique, which uses a section of the jejunum (the middle part of the small intestine) as a replacement for the missing section of esophagus. This procedure generally results in shorter stays and fewer complications than alternatives, such as colonic interpositions or gastric pull-ups.

Because children with EA are at higher risk for experiencing acid reflux, Barrett's esophagus (a precancerous condition) and other concerns, they should undergo follow-up endoscopy at least once after surgical repair, as well as if they develop new or worsening symptoms.