Is Fetal Endoscopic Tracheal Occlusion (FETO) a Predisposing Factor for Acid Gastro-Esophageal Reflux in Infants With Congenital Diaphragmatic Hernia?

Abstract

Introduction: Various anatomical defects predispose patients with congenital diaphragmatic hernia (CDH) to develop gastroesophageal reflux disease (GERD). The fetal endoscopic tracheal occlusion (FETO) has increased the survival of patients with severe CDHs. The aim of this study was to study GERD in patients who underwent FETO. Materials and Methods: We included patients with CDH treated with or without FETO ("FETO" and "no-FETO" group, respectively) from 2013 to 2016. Data on gestational age (GA), birth weight (BW), initial observed/expected lung to head ratio (O/E LHR), final O/E LHR, duration of ventilation and hospitalization, maximal tracheal diameter, and pulmonary volume were collected. All patients underwent pH-metry after 1 year of life, and the results were compared between groups and correlated to risk factors. Results: Thirty-two patients were included in the study: 10 FETO and 22 no-FETO. No significant differences were observed in the pH-metric results of the two groups. No correlation was found between GA, BW, initial O/E LHR, maximal tracheal diameter, pulmonary volume, and pH-metric results. pH-metric results were correlated with the total duration of ventilation (R = 0.5, p = 0.003) and of hospitalization (R = 0.54, p = 0.001). Gastric herniation is associated with the worse pH-metric result. Conclusions: The FETO procedure does not seem to represent an independent risk factor for GERD. However, patients with the most severe CDH have the worst GERD.

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

“…A total of 858 records were identified, of which 90 were retrieved for full‐text review. Twenty‐five articles published between 2003 and 2022 were included in the qualitative synthesis 12–36 , and data from 20 articles were included in the quantitative synthesis (Figure 1) 12–14,17–19,21–25,27–30,32–36 . Among them, the four RCTs 12–14, 21 were rated as having a low risk of bias using the RoB‐2 tool, while, among the 16 cohort studies 17–19,22–25,27–30,32–36 , three were rated as having a low risk, 11 were rated as having a moderate risk and two were rated as having a serious risk of bias using the ROBINS‐I tool (Table 1, Figure 2).…”

“…Twenty-five articles published between 2003 and 2022 were included in the qualitative synthesis , and data from 20 articles were included in the quantitative synthesis (Figure 1) [12][13][14][17][18][19][21][22][23][24][25][27][28][29][30][32][33][34][35][36] . Among them, the four RCTs [12][13][14]21 were rated as having a low risk of bias using the RoB-2 tool, while, among the 16 cohort studies [17][18][19][22][23][24][25][27][28][29][30][32][33][34][35][36] , three were rated as having a low risk, 11 were rated as having a moderate risk and two were rated as having a serious risk of bias using the ROBINS-I tool (Table 1, Figure 2). A total of 1187 CDH patients were included in the meta-analysis, among whom 639 underwent FETO.…”

“…The potential complications included the rates of PPROM before 37 weeks 12,13,21 , preterm birth before 37 weeks 12,13,21,23,34,36 , preterm birth before 32 weeks 12,13,19,21 , placental abruption [12][13][14]19 , chorioamnionitis 12,13 , use of prosthetic patch after delivery 12-14, 17,22,30,33 and tracheal enlargement 25,35 . FETO was associated with a significantly increased rate of PPROM before 37 weeks (OR, 4.94 (95% CI, 2.25-10.88); P < 0.0001, I 2 = 39%, NNH = 3.13) (high quality of evidence) (Figure S3a) and preterm birth before 37 weeks (OR, 5.24 (95% CI, 3.33-8.23); P < 0.00001, I 2 = 0%, NNH = 2.79) (moderate quality of evidence) (Figure 5a).…”

Unsolved problems in CDH follow-up

“…Fetal endoscopic tracheal occlusion (FETO) was mentioned as a possible factor increasing the risk of GER occurrence, but retrospective multi-center studies performed by Cordier and Leva revealed that the procedure does not impact on global gastrointestinal morbidity at 2 years of age ( 56 , 57 ).…”

Recurrence of Congenital Diaphragmatic Hernia: Risk Factors, Management, and Future Perspectives

“…Recurrence of Congenital Diaphragmatic Hernia (CDH) represents a common complication in CDH survivors, along with pulmonary, gastrointestinal, neurobehavioral, and developmental anomalies (1)(2)(3)(4). It mostly happens at the site of the original hernia, but occasionally hiatal hernia may follow CDH repair due to tension on the diaphragmatic crura.…”