Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Postoperative Complications of Esophageal Atresia and Role of Endoscopic Balloon Dilatation in Anastomotic Strictures

  • Cho, Jin Young (Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Chang, Mea-young (Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Gang, Mi Hyeon (Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Lee, Yong Wook (Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Park, Jun Beom (Division of Pediatric Surgery, Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Kim, Jae Young (Department of Pediatrics, Gyeongsang National University Changwon Hospital) ;
  • Kim, Hyun Jin (Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine)
  • Received : 2022.05.16
  • Accepted : 2022.09.18
  • Published : 2022.11.15
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Abstract

Purpose: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a congenital anomaly that can cause frequent digestive and nutritional problems, even after repair. The most common complication is anastomotic stricture, for which reoperation or balloon dilatation is performed. This study aimed to evaluate the postoperative complications of EA and the role of endoscopic balloon dilatation (EBD) in cases of anastomotic stricture. Methods: We retrospectively analyzed patients diagnosed with EA with or without TEF between January 2000 and February 2021. Patients' baseline characteristics, associated anomalies, and postoperative complications were reviewed. Results: Among 26 patients, 14 (53.8%) were male, 12 (46.2%) had coexisting anomalies, and the median follow-up was 6.1 years (range, 1.2-15.7 years). In univariate analysis, prematurity, low birth weight, and long-gap EA were associated with postoperative complications in 12 (46.2%) patients. Among the 10 (38.5%) patients with anastomotic stricture, nine (90.0%) required EBD. Regarding the first EBD, it was performed at a median of 3.3 months (range, 1.2-7.6 months) post-repair, while the average patient weight was 4.6 kg. The mean diameter ranged from 3.3 to 9.1 mm without major complications. In univariate analysis, long-gap EA alone was significantly associated with EBD. Conclusion: Approximately half of the patients experienced complications after EA repair. In particular, patients with a long-gap EA had a significantly increased risk of complications, such as anastomotic strictures. EBD can be safely used, even in infants.

Keywords

References

  1. Pinheiro PF, Simoes e Silva AC, Pereira RM. Current knowledge on esophageal atresia. World J Gastroenterol 2012;18:3662-72. https://doi.org/10.3748/wjg.v18.i28.3662
  2. Tovar JA, Fragoso AC. Current controversies in the surgical treatment of esophageal atresia. Scand J Surg 2011;100:273-8. https://doi.org/10.1177/145749691110000407
  3. Sfeir R, Bonnard A, Khen-Dunlop N, Auber F, Gelas T, Michaud L, et al. Esophageal atresia: data from a national cohort. J Pediatr Surg 2013;48:1664-9. https://doi.org/10.1016/j.jpedsurg.2013.03.075
  4. Mahoney L, Rosen R. Feeding problems and their underlying mechanisms in the esophageal atresiatracheoesophageal fistula patient. Front Pediatr 2017;5:127. https://doi.org/10.3389/fped.2017.00127
  5. Gottrand M, Michaud L, Sfeir R, Gottrand F. Motility, digestive and nutritional problems in esophageal atresia. Paediatr Respir Rev 2016;19:28-33.
  6. Baird R, Laberge JM, Levesque D. Anastomotic stricture after esophageal atresia repair: a critical review of recent literature. Eur J Pediatr Surg 2013;23:204-13. https://doi.org/10.1055/s-0033-1347917
  7. Campos J, Tan Tanny SP, Kuyruk S, Sekaran P, Hawley A, Brooks JA, et al. The burden of esophageal dilatations following repair of esophageal atresia. J Pediatr Surg 2020;55:2329-34. https://doi.org/10.1016/j.jpedsurg.2020.02.018
  8. Ghiselli A, Bizzarri B, Ferrari D, Manzali E, Gaiani F, Fornaroli F, et al. Endoscopic dilation in pediatric esophageal strictures: a literature review. Acta Biomed 2018;89(8-S):27-32.
  9. Bairdain S, Zurakowski D, Vargas SO, Stenquist N, McDonald M, Towne MC, et al. Long-gap esophageal atresia is a unique entity within the esophageal atresia defect spectrum. Neonatology 2017;111:140-4. https://doi.org/10.1159/000449241
  10. Friedmacher F, Kroneis B, Huber-Zeyringer A, Schober P, Till H, Sauer H, et al. Postoperative complications and functional outcome after esophageal atresia repair: results from longitudinal singlecenter follow-up. J Gastrointest Surg 2017;21:927-35. https://doi.org/10.1007/s11605-017-3423-0
  11. Dingemann C, Dietrich J, Zeidler J, Blaser J, Gosemann JH, Ure BM, et al. Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of 8 million. Dis Esophagus 2016;29:780-6. https://doi.org/10.1111/dote.12369
  12. Chang EY, Chang HK, Han SJ, Choi SH, Hwang EH, Oh JT. Clinical characteristics and treatment of esophageal atresia: a single institutional experience. J Korean Surg Soc 2012;83:43-9. https://doi.org/10.4174/jkss.2012.83.1.43
  13. Rayyan M, Embrechts M, Van Veer H, Aerts R, Hoffman I, Proesmans M, et al. Neonatal factors predictive for respiratory and gastro-intestinal morbidity after esophageal atresia repair. Pediatr Neonatol 2019;60:261-9. https://doi.org/10.1016/j.pedneo.2018.07.003
  14. Ritz LA, Widenmann-Grolig A, Jechalke S, Bergmann S, von Schweinitz D, Lurz E, et al. Outcome of patients with esophageal atresia and very low birth weight (≤ 1,500 g). Front Pediatr 2020;8:587285. https://doi.org/10.3389/fped.2020.587285
  15. Li XW, Jiang YJ, Wang XQ, Yu JL, Li LQ. A scoring system to predict mortality in infants with esophageal atresia: a case-control study. Medicine (Baltimore) 2017;96:e7755. https://doi.org/10.1097/MD.0000000000007755
  16. Ko D, Lee C, Youn JK, Yang HB, Kim HY. Do children with esophageal atresia show worse growth outcomes? Adv Pediatr Surg 2020;26:54-60. https://doi.org/10.13029/aps.2020.26.2.54
  17. Koivusalo A, Suominen J, Rintala R, Pakarinen M. Location of TEF at the carina as an indicator of longgap C-type esophageal atresia. Dis Esophagus 2018;31:doy044.
  18. Shah R, Varjavandi V, Krishnan U. Predictive factors for complications in children with esophageal atresia and tracheoesophageal fistula. Dis Esophagus 2015;28:216-23. https://doi.org/10.1111/dote.12177
  19. Rassiwala M, Choudhury SR, Yadav PS, Jhanwar P, Agarwal RP, Chadha R, et al. Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome. J Indian Assoc Pediatr Surg 2016;21:126-30. https://doi.org/10.4103/0971-9261.182587
  20. Okata Y, Maeda K, Bitoh Y, Mishima Y, Tamaki A, Morita K, et al. Evaluation of the intraoperative risk factors for esophageal anastomotic complications after primary repair of esophageal atresia with tracheoesophageal fistula. Pediatr Surg Int 2016;32:869-73. https://doi.org/10.1007/s00383-016-3931-0
  21. Tambucci R, Angelino G, De Angelis P, Torroni F, Caldaro T, Balassone V, et al. Anastomotic strictures after esophageal atresia repair: incidence, investigations, and management, including treatment of refractory and recurrent strictures. Front Pediatr 2017;5:120. https://doi.org/10.3389/fped.2017.00120
  22. Chang CH, Chao HC, Kong MS, Chen SY, Chen CC, Lai MW. Clinical and nutritional outcome of pediatric esophageal stenosis with endoscopic balloon dilatation. Pediatr Neonatol 2019;60:141-8. https://doi.org/10.1016/j.pedneo.2018.04.013