Outcome and management in infants with esophageal atresia – A single centre observational study

Donoso, Felipe; Kassa, Ann-Marie; Gustafson, Elisabet; Meurling, S; Lilja, Heléne Engstrand

doi:10.1016/j.jpedsurg.2016.03.010

Cited by 36 publications

(29 citation statements)

References 34 publications

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“…The development of an AS after EA repair result in a significant morbidity and despite efforts to solve this problem its incidence has remained at the same level for the last decades. 13,14 A Canadian Association of Pediatric Surgeons annual meeting survey found that 74% of the attending surgeons prescribed anti-reflux medication prophylactically after EA repair. 22 In a prospective multicenter cohort study from the United Kingdom and Ireland including 151 infants, 51.6% of patients received prophylactic anti-reflux medication after EA repair.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12] Anastomotic strictures (AS) stand for a significant proportion of that morbidity affecting 50% (range 13-78%) of all infants after EA repair. 2,4,5,[13][14][15][16][17][18][19][20][21][22] Gastroesophageal reflux (GER), anastomotic tension, and leakage are known risk factors of AS. 14 In adults with GER, the decreased incidence of esophageal stricture formation is associated with an increase in the use of proton pump inhibitors (PPI).…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Anastomotic Strictures after Esophageal Atresia Repair: Prophylactic Proton Pump Inhibitors Do Not Reduce the Incidence of Strictures

Donoso

Lilja

2016

Eur J Pediatr Surg

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Since 2005, infants with esophageal atresia (EA) in our unit are given prophylactic proton pump inhibitors (PPI) after repair until 1 year of age. The aims of this study were to identify risk factors for anastomotic strictures (AS) and to assess the efficacy of postoperative PPI prophylaxis in reducing the incidence of AS compared with symptomatic PPI. Patients who underwent EA repair from 1994 to 2013 in our unit were included in this retrospective observational study approved by the local ethics review board. They were divided into two subgroups; symptomatic PPI-group with EA repair from 1994 to 2004 and prophylactic PPI-group with EA repair from 2005 to 2013. Data were collected from the patient records. Potential risk factors for AS analyzed were gender, long gap EA, birth weight, premature birth (<37 gestational weeks), anastomotic tension, and anastomotic leakage. Number of dilatations until the age of 1 and 5 years were recorded. To evaluate risk factors for AS and the effect of prophylactic PPI Logistic, Cox and Poisson regression models were used. For descriptive statistics Fisher exact test and Wilcoxon rank sum test were used. A total of 128 patients were included. Patient characteristics, surgical method, grading of anastomotic tension, complications, and survival rates did not differ significantly between the symptomatic PPI-group ( = 71) and the prophylactic PPI-group ( = 57). Comparing the symptomatic and prophylactic PPI-group, there was no significant difference in the median age at the first AS (9.3 vs 6 mo), the number of dilatations until 1 year (2 vs 2) and 5 years (5 vs 4), or the incidence of anastomotic stricture (56.5% vs 50.9%). Long gap EA, high birth weight, and anastomotic tension were found to be independent risk factors. Surgeons should aim to perform anastomosis under less tension at EA repair. Prophylactic PPI-treatment does not appear to reduce the rate of AS. Randomized controlled trials with larger study populations are needed to further evaluate the efficacy of prophylactic PPI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Anastomotic Strictures after Esophageal Atresia Repair: Prophylactic Proton Pump Inhibitors Do Not Reduce the Incidence of Strictures

Donoso

Lilja

2016

Eur J Pediatr Surg

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“…[1–4] With improvements in surgical and perioperative care, survival rates now exceed 90%. [4, 5] This increased survival prompts a need to focus on long-term complications. The most common problems patients with EA are at risk for include: gastroesophageal reflux disease (GERD) with or without esophagitis, Barrett’s esophagus (BE), dysphagia, strictures, eosinophilic esophagitis, feeding and nutritional problems, recurrent respiratory tract infections, persistent cough, and wheezing.…”

Section: Introductionmentioning

confidence: 99%

How to Care for Patients with EA-TEF: The Known and the Unknown

Mousa

Krishnan

Hassan

et al. 2017

Curr Gastroenterol Rep

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EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.

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“…Sonuçlar karşılaştırıldığında iki teknik arasında anlamlı bir fark olmadığı görülmektedir (12)(13)(14). Buna rağmen özefagus atrezisi tedavisinde torakoskopik yöntemi kullanan çocuk cerrahisi uzmanlarının oranı halen %10 un üzerine çıkmamıştır (2,15).…”

Section: Ameliyat Sonrası Takipunclassified

“…Asit süpresyonu uygulanan ve uygulanmayan hastalar arasında anastomoz darlığı gelişimi açısından fark olmadığını söyleyen yazarlar olsa da cerrahların %74'ü ameliyat sonrası standart olarak proton pompa inhibitörü veya H 2 reseptör blokörü kullanır (15,20,21). Tedavide erken fundoplikasyonları öneren yazarların yanında yoğun medikal tedaviyi önerenler de vardır (2). İnfantlarda anti-reflü ameliyatı sonrası nükslerin yaklaşık %40'larda olması bir yana, özefajiyal dismotilitenin zaten sorun olduğu bu hastalarda, fundoplikasyonun sorunu daha da artırabileceği unutulmamalıdır (1,21 (4,21,22).…”

Section: Sonuçlarunclassified

Özefagus Atrezisi: Tek Cerrah, Tek Merkez Deneyimi ve Sonuçları

Okumuş¹

2020

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ÖZETAmaç: Çocuk cerrahisi kliniklerinin indeks vakalarından biri olan özefagus atrezisi halen ayrı bir öneme sahiptir. Başarılı sonuçlar için multidisipliner yaklaşım, donanımlı bir klinik ve cerrahi tecrübe gerekir. Sıklıkla büyük eğitim hastanelerinde tedavileri yapılsa da, donanımlı özel hastanelerde de başarılı sonuçlar alınabileceğini göstermek istedik. Materyal veMetot: Geriye dönük gözlem olarak planlanan çalışma için, 2007 ve 2017 yılları arasında kliniğimizde özefagus atrezisi tanısı konulmuş ve tedavisi yapılmış, hastalar çalışmaya dahil edildi. Sonuçlar: Toplam 29 hasta çalışmaya dahil edildi. 29 hastanın 28'sinde primer anastomoz yapılabildi. Ortalama takip süresi 48,5 ay olarak bulundu. Tüm grupta sağkalım oranı %89,6 olarak saptandı. Anastomoz kaçağı olan hastaların oranı %17,8 olarak bulunurken, anastomoz darlığı hastaların %50'sinde saptandı. Çalışmaya dahil edilen 29 yenidoğanın 17'si erkek (%58,6) ve 12'si kızdı (%41,4). Ortalama gestasyonel yaş 36,2±2,4 olarak saptanırken, ortalama ağırlık 2470±687 gram olarak bulundu. Çok düşük doğum ağırlığı (<1500 gr.) olan 4 hasta mevcuttu. Kardiyak anomali 15 hastada (%51,7) saptanırken, VACTERL sendromu 4 hastada saptandı. Tartışma: Multidisipliner çalışma sayesinde özefagus atrezisinin tanı ve tedavisinde büyük gelişmeler sağlanmaktadır. Önceden büyük eğitim hastanelerinde tedavileri yapılabiliyor olsa da, günümüzde yeterli alt yapısı olan diğer hastanelerde de başarıyla tedavi edilebileceğini düşünmekteyiz. Anahtar sözcükler: Özefagus atrezisi, Trakeoözefajiyal Fistül ESOPHAGEAL ATRESIA: SINGLE SURGEON, SINGLE CENTER EXPERIENCE AND RESULTS ABSTRACT Objective: Esophageal atresia, one of the index cases of pediatric surgery clinics, is still of particular importance. A multidisciplinary approach, a well-equipped clinic and surgical experience are required for successful results. Although it is often done in large training hospitals, we aimed to show that satisfactory results can be obtained in any specialized hospital. Material and Method: Medical records of infants with repaired esophageal atresia from 2007 to 2017 were reviewed.Results: A total of 29 patients were included in the study. The primary anastomosis was performed in 28 of 29 patients. The median follow-up was 48.5 months. The overall survival rate was 89.6%. Incidence of anastomotic leakage was 17.8%, anastomotic stricture 50% (33.3% within the first year). Recurrent fistula and vocal cord paresis were not revealed. Trans-anastomotic stent and chest drain were routinely used. The mean gestational age was found to be 36.2±2.4 and the mean weight was 2470±687 grams. There were 4 patients with very low birth weight (<1500 g). The cardiac anomaly was detected in 15 patients (51.7%) and VACTERL syndrome was detected in 4 patients.Conclusions: Great advances in diagnosis and treatment are provided related to the multidisciplinary approach. Although the treatment of esophageal atresia could be performed in large training hospitals up to date, we think that it can be successfully treated in other hos...

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Outcome and management in infants with esophageal atresia – A single centre observational study

Cited by 36 publications

References 34 publications

Risk Factors for Anastomotic Strictures after Esophageal Atresia Repair: Prophylactic Proton Pump Inhibitors Do Not Reduce the Incidence of Strictures

Risk Factors for Anastomotic Strictures after Esophageal Atresia Repair: Prophylactic Proton Pump Inhibitors Do Not Reduce the Incidence of Strictures

How to Care for Patients with EA-TEF: The Known and the Unknown

Özefagus Atrezisi: Tek Cerrah, Tek Merkez Deneyimi ve Sonuçları

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