Prophylactic effect of H2 blocker for anastomotic stricture after esophageal atresia repair

Abstract

Background: Anastomotic stricture is the main complication after esophageal atresia (EA) repair. In this study, we assessed the efficacy of long-term prophylactic H2 blocker treatment in preventing stricture. Methods: Twenty-seven patients who had undergone primary repair for EA (Gross type C) were reviewed retrospectively. The patients were analyzed in two groups: the H2 blocker group (n = 13), in which the patients were treated with prophylactic H2 blocker; and the control group (n = 14), in which they were not. To assess anastomotic stricture, contrast esophagography was performed and the number of patients who required balloon dilatation was recorded.Results: Five patients (18.5%) required postoperative balloon dilatation within 1 year of primary repair. There was no difference in dilatation rate between the two groups. In the H2 blocker group, however, anastomotic stricture improved significantly in the late postoperative period relative to that in the early postoperative period. In contrast, in the control group, anastomotic stricture did not improve after a long postoperative period. The incidence of gastroesophageal reflux was 55.6%. Postoperative gastroesophageal reflux was a predisposing factor for balloon dilatation in the control group, but not in the H2 blocker group. Conclusions: Long-term treatment with prophylactic H2 blocker may prevent anastomotic stricture caused by gastroesophageal reflux in the late postoperative period after EA repair.

Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study

“…Both in the present and in earlier studies leakage was predictive of anastomotic stricture formation 26 27. We assume that leakage enhances inflammation and scarring of the anastomotic area.…”

“…Another factor thought to increase stricture development is GORD 5 11 26 27. Studies are hard to compare as different definitions of GORD are used.…”

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

“…[23] However, in the late postoperative period, those receiving H2RAs had a greater improvement in their stricture.…”

Prolonged Use of Proton Pump Inhibitors as Stricture Prophylaxis in Infants with Reconstructed Esophageal Atresia

“…1 A correlation between esophageal stricture in EA and gastroesophageal reflux (GER) has been reported, 2,3 and GER is further linked with a higher risk of esophageal ulcers and distal esophageal strictures or even mucosal metaplasia. 4 Proton pump inhibitors (PPIs) are administered on a routine basis postoperatively to prevent negative effects of GER, such as AS. In a previous publication, researchers found no difference in development of AS with or without 3 months of PPI prophylaxis.…”