ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management

Abstract

Introduction Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature. Materials and Methods Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9. Results Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1–9). Eight of these (62%) did not reach consensus. Conclusion Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery.

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Follow-up and Framework

“…The general methodological approach has been recently published when presenting the first part of the ERNICA consensus conference on Diagnostics, Preoperative, Operative and Postoperative Management. 18 The second part which is reported in this manuscript differed from the first part in details. Therefore, the two parts are presented separately.…”

“…The preparation and implementation of the conference included the following steps: 18 (1) generation of a list of items; (2) prioritization of the items using the online REDCap electronic data capture tools; 20 (3) discussion of all items during the conference, formulation of statements; (4) anonymous voting via the internet-based system VoxVote. 21 The items of this second part of the conference focused on the domains Follow-up and Framework.…”

“…With regard to literature search, publications with the highest grade of evidence according to the CEBM (center for evidence-based medicine) classification were suggested to be preferred 22 as previously reported. 18 Literature was distributed and made available to all participants via a DropBox (Dropbox Inc., San Francisco, California, United States, 2007) link prior to the conference.…”

“…Consensus was defined as !75% of those voting scored 6, 7, 8, or 9, excluding those who declared no relevant expertise on that statement. 18…”

“…In this first ERNICA consensus conference focusing on the management of patients with EA and TEF, two priorities were addressed: The recently published results of the first part of the ERNICA consensus conference focused on Diagnostics, Preoperative, Operative and Postoperative Management. 18 The second part of the conference mainly dealt with Follow-up and Framework from a surgical perspective which will be presented in the following.…”