Anastomotic strictures and endoscopic dilatations following esophageal atresia repair

Filippo Parolini, Ernesto Leva, Anna Morandi, Francesco MacChini, Valerio Gentilino, Antonio Di Cesare, Maurizio Torricelli

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To identify risk factors that can predict prevalence of anastomotic strictures (AS) following esophageal atresia (EA) repair. Methods: Of 46 consecutive patients with EA managed at our institution between 2004 and 2012, 35 underwent esophageal anastomosis and were included in this retrospective longitudinal study. Routine endoscopy was performed 1 month after surgical repair. According to stricture index (SI), endoscopically calculated as SI = (D - d)/D, where D is the diameter of the esophageal pouch and d the stricture diameter, population was divided into Group 1, SI ≤ 0.1 (no evidence of stricture); Group 2, 0.3 > SI > 0.1 (mild stricture); Group 3, SI ≥ 0.3 (high-grade stricture). Trends of subsequent endoscopic esophageal dilatations were compared between the groups using Wilcoxon-Mann-Whitney or Pearson's tests. Cox regression analysis was performed to estimate the hazard ratio. Results: Gastro-esophageal reflux disease (P = 0.04), tension on the anastomosis (P = 0.02) and long-gap form (P = 0.008) have an increased risk of developing AS. SI at 1 month after surgery correlates with the average number of future dilatations: Group 2 and 3 compared to Group 1 required more dilatations (hazard ratio 2.291 and 12.765). Conclusion: AS remain frequent complications of esophageal surgery, especially in specific subgroups of patients. SI at 1 month after surgery could already predict the severity of the stricture and the need for subsequent endoscopic esophageal dilatations.

Original languageEnglish
Pages (from-to)601-605
Number of pages5
JournalPediatric Surgery International
Volume29
Issue number6
DOIs
Publication statusPublished - Jun 2013

Keywords

  • Anastomotic stricture
  • Balloon dilatation
  • Children
  • Esophageal atresia
  • Gastroesophageal reflux disease
  • Newborn

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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