Off-Label Biliary Stents for Refractory Anastomotic Strictures and Leaks After Esophageal Atresia Repair in Infants

Anastomotic strictures and leaks are frequent complications following the surgical repair of esophageal atresia, with a subset of patients developing refractory disease despite repeated dilations. This series evaluates the preliminary feasibility and outcomes of using off-label, fully covered self-expanding metal biliary stents in infants with refractory anastomotic strictures or leaks. Six infants treated at a tertiary referral center between 2021 and 2025 underwent endoscopic placement of fully covered self-expanding metal biliary stents. Technical success in stent placement and removal was achieved in all cases (100%). Clinical success was observed in 83.3% of patients; specifically, complete sealing of leaks and perforations was achieved in 100% of cases, while sustained luminal patency was observed in half of the isolated refractory strictures. One patient with a long-segment stricture required subsequent surgical revision. No major adverse events were identified during a median follow-up of 2.75 years. These preliminary findings suggest that biliary stents may represent a feasible rescue option for managing complex postoperative esophageal atresia complications in infants when specialized pediatric devices are unavailable.