TY - JOUR
T1 - Anastomotic strictures and endoscopic dilatations following esophageal atresia repair
AU - Parolini, Filippo
AU - Leva, Ernesto
AU - Morandi, Anna
AU - MacChini, Francesco
AU - Gentilino, Valerio
AU - Di Cesare, Antonio
AU - Torricelli, Maurizio
PY - 2013/6
Y1 - 2013/6
N2 - 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.
AB - 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.
KW - Anastomotic stricture
KW - Balloon dilatation
KW - Children
KW - Esophageal atresia
KW - Gastroesophageal reflux disease
KW - Newborn
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U2 - 10.1007/s00383-013-3298-4
DO - 10.1007/s00383-013-3298-4
M3 - Article
C2 - 23519549
AN - SCOPUS:84878576669
VL - 29
SP - 601
EP - 605
JO - Pediatric Surgery International
JF - Pediatric Surgery International
SN - 0179-0358
IS - 6
ER -