Esophageal atresia/tracheoesophageal fistula (EA/TEF) causes gastrointestinal (GI) complications that can begin in infancy and extend into adulthood. The etiology of these is frequently multifactorial, and they can adversely affect feeding, growth, respiratory health, and overall quality of life. This review highlights the importance of early diagnosis, multidisciplinary surveillance, and individualized treatment strategies to effectively manage these complications and improve long-term outcomes for affected children.

Recent studies have focused on the development of evidence-based surveillance protocols to optimally manage the numerous observed EA/TEF-associated digestive complications. Many of these complications stem from the combination of gastroesophageal dysmotility and mechanical obstruction inherent to EA/TEF and its surgical management, and include gastroesophageal reflux disease, feeding difficulties, dysphagia, eosinophilic esophagitis, and pulmonary consequences of aspiration. Management of GI complications in children with EA/TEF requires careful, multidisciplinary evaluation and treatment, incorporating dietary modifications, feeding therapy, pharmacotherapy, and surgical and endoscopic interventions.

Magnetic anastomosis is an innovative technique for establishing esophageal continuity in infants born with esophageal atresia. Few case series featuring this technology have been published, with even fewer reports on complications. We present the entire Canadian experience with this approach.

A nationwide retrospective review of all esophageal atresia patients treated with magnetic anastomoses in Canada was conducted through the Canadian Consortium for Research in Pediatric Surgery (CanCORPS).

Magnetic anastomoses were attempted in nine patients including four Type A, two Type B, and three Type C. The median pre-operative esophageal gap was 2.9 cm (range 0.0-5.5 cm). In four patients, magnetic anastomosis was used as a salvage technique, after failed attempted primary repair. Seven patients (78 %) achieved esophageal patency after magnet insertion. Strictures developed in all successful cases and required a median of 10 dilatations (range 3-16). In one patient with a failed anastomosis, the proximal magnet perforated the proximal esophageal pouch, while in the second case, the magnets failed to couple together. One patient had an anastomosis form but required operative intervention shortly afterwards to both revise the anastomosis and address a missed proximal fistula.

In the Canadian experience, magnetic anastomosis was successful in establishing esophageal continuity in most patients. However, all patients developed strictures requiring multiple dilatations, and there was a substantial risk of complications requiring additional operative procedures. Further refinement of this technique may establish magnetic anastomosis as another tool for the pediatric surgeon treating long-gap and other challenging cases of esophageal atresia.

Diagnostic and therapeutic endoscopic procedures in children are fundamental to the subspecialty of pediatric gastroenterology. This review highlights significant advancements and trends in pediatric endoscopy, emphasizing the transformative impact of technological innovations in the field. The advent of ultra-thin endoscopes and the development of minimally-invasive techniques have markedly enhanced both diagnostic and therapeutic capabilities, leading to safer and more effective procedures for pediatric patients. Key advancements include transnasal endoscopy, endoscopic ultrasound, and per-oral endoscopic myotomy.

Although pediatric neurogastroenterology and motility (PNGM) disorders are prevalent, often debilitating, and remain challenging to diagnose and treat, this field has made remarkable progress in the last decade. Diagnostic and therapeutic gastrointestinal endoscopy emerged as a valuable tool in the management of PNGM disorders. Novel modalities such as functional lumen imaging probe, per-oral endoscopic myotomy, gastric-POEM, and electrocautery incisional therapy have changed the diagnostic and therapeutic landscape of PNGM. In this review, the authors highlight the emerging role of therapeutic and diagnostic endoscopy in esophageal, gastric, small bowel, colonic, and anorectal disorders and disorders of gut and brain axis interaction.