Long-term analysis of children with esophageal atresia and tracheoesophageal fistula

doi:10.1016/S0022-3468(03)00110-6

Journal of Pediatric Surgery

Volume 38, Issue 6, June 2003, Pages 852-856

Presented at the 54th Annual Meeting of the Section on Surgery of the American Academy of Pediatrics, Boston, Massachusetts, October 18-20, 2002.

https://doi.org/10.1016/S0022-3468(03)00110-6 Get rights and content

Abstract

Background/purpose

For children with esophageal atresia (EA) or tracheoesophageal fistula (TEF), the first years of life can be associated with many problems. Little is known about the long-term function of children who underwent repair as neonates. This study evaluates outcome and late sequelae of children with EA/TEF.

Methods

Medical records of infants with esophageal anomalies (May 1972 through December 1990) were reviewed. Study parameters included demographics, dysphagia, frequent respiratory infections (> 3/yr), gastroesophageal reflux disease (GERD), frequent choking, leak, stricture, and developmental delays (weight, height < 25%, < 5%, respectively).

Results

Over 224 months, 69 infants (37 boys, 32 girls) were identified: type A, 10 infants; type B, 1; type C, 53; type D, 4; type E, 1. Mean follow-up was 125 months. During the first 5 years of follow-up, dysphagia (45%), respiratory infections (29%), and GERD (48%) were common as were growth delays. These problems improved as the children matured.

Conclusions

Children with esophageal anomalies face many difficulties during initial repair and frequently encounter problems years later. Support groups can foster child development and alleviate parent isolationism. Despite growth retardation, esophageal motility disorders, and frequent respiratory infections, children with EA/TEF continue to have a favorable long-term outcome.

Section snippets

Materials and methods

From May 1972 to December 1990 (18.7 years), 69 children with EA/TEF have been treated at our institution and were available for long-term follow-up. Study approval from the institutional review board (IRB) was obtained. The medical records of these infants were reviewed to discover residual symptoms or complications that arose during infancy, elementary years, or teenage years. Children were seen annually in clinic. Symptoms and parental concerns were evaluated at 5-year intervals. The study

Results

Thirty-seven boys and 32 girls were included in the study. Initial repair was carried out through a right extrapleural thoracotomy with division of TEF and primary single layer esophagoesophagostomy, often with prior gastrostomy placement. Esophageal replacement with colonic interposition was utilized in 7 of 10 type A patients. Forty-nine infants (71%) received gastrostomy tubes at the discretion of the attending surgeon. Gastrostomy was maintained until the child showed adequate nutritional

Discussion

Children with EA/TEF have a significant incidence of gastroesophageal reflux. Postoperatively, esophageal motility disorders are observed. Esophageal peristalsis is impaired, whereas the lower esophageal sphincter may be incompetent.5, 6, 7 Several studies have reported an increased incidence of gastroesophageal reflux after EA/TEF repair; however, the definitions have not been uniform. Furthermore, discrepancy between subjective reflux and documented gastroesophageal reflux disease is likely

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This study aimed to retrospectively investigate congenital esophageal stenosis (CES) cases managed at our institution using a non-aggressive strategy based on a step-up approach from esophageal balloon dilatations to surgery.
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Nineteen patients, confirmed with radiologic and endoscopic investigations, were managed. Complete symptom resolution was achieved in 14 patients by a median of five (2–15) recurrent esophageal balloon dilatations lasting for 7.5 (2–108) months. Two more patients, after 7 and 15 dilatations, had mild dysphagia, not interfering with their daily living. One patient, in whom the initial dilatation attempt with 3 atm was unsuccessful, and two patients with persistent symptoms and growth retardation despite ongoing dilatation treatment, underwent surgery. After 48 (12–132) months of follow-up, 17 patients were symptom-free.
Conservative treatment with esophageal balloon dilatations is an efficient and reliable modality that can be used as a first-line treatment in CES. Surgical treatment option should be used when dilatation attempt is unsuccessful, or symptoms and growth retardation persist despite dilatation treatment.
Nationwide analysis of mortality and hospital readmissions in esophageal atresia
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The purpose of this study is to identify determinants of mortality and hospital readmission in infants born with esophageal atresia ± tracheoesophageal fistula.
The Nationwide Readmissions Database (2010–2014) was queried for newborns with a diagnosis of esophageal atresia. Outcomes included mortality and readmissions at 30-day and 1-year.
3157 patients were identified, of which 54% were male. 81% had an additional congenital anomaly, and 35% had VACTERL association. Overall mortality at index hospitalization was 11% (n = 360) and was significantly higher with additional congenital anomalies (13%), VACTERL (19%), and Spitz classification II/III (18%) vs. isolated esophageal atresia/tracheoesophageal fistula (4%), all p < 0.001. After esophageal atresia repair (n = 2179), 10% (n = 212) were readmitted within 30 days and 26% (n = 563) within 1 year, with 17% admitted to different hospitals. Common diagnoses during readmission were GERD (54%), infections (42%), failure to thrive (17%), tracheomalacia (14%), and esophageal stricture (10%). Unplanned readmissions accounted for 85% of readmissions. A large number underwent operative procedures, most commonly esophageal dilation (17%) and fundoplication/gastrostomy (12%).
Our study has uncovered a high likelihood of complications and unplanned readmission within the first year of life for newborns with esophageal atresia. Coordinated multidisciplinary care may help to decrease unnecessary readmissions and improve outcomes in this vulnerable population.
Retrospective comparative analysis.
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Long term outcomes of gastric transposition (GT) for complex esophageal atresia (EA) are poorly reported. We aimed to perform comprehensive long term follow up of adults who had been treated with GT for EA as children.
Consecutive patients who underwent GT for EA in childhood aged > 18 years old were identified alongside age matched patients who had primary repair (PR). Type of EA, comorbidities and details of surgery were recorded. Telephone interviews included medical history, current symptoms — including gastrointestinal symptom rating scale (GSRS), morbidity and health related quality of life (HRQoL) using gastrointestinal quality of life index (GIQLI).
32 participants were interviewed in each group (mean age 29 years). BMI (19.9 ± 3.5) was significantly lower (p = 0.0006) in GT group. 6/32 (19%) still required supplementary feeding. Adult morbidity included anastomotic stricture (34%), chronic respiratory disease (28%), dumping symptoms (25%), anemia (47%) and depression (19%). 3 patients required major revision surgery.
Participants in both groups report regular upper gastrointestinal symptoms (GSRS: GT = 2.1, PR = 2.0) and were more symptomatic than the normal population (1.4) but not statistically different from each other. HRQoL (GIQLI = 113) was lower than after PR (122) but not significantly different (p = 0.29) and the normal population (125). 23% of GT participants had higher than normal HRQoL.
GT for EA is associated with significant morbidity and symptoms, including issues previously unreported in adulthood such as mental health problems. This mandates long term follow up and quality transition of these patients into adult care.
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Proton pump inhibitors in esophageal atresia: A systematic review and meta-analysis
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Gastro-esophageal and respiratory morbidity in children after esophageal atresia repair: a 23-year review from a single tertiary institution in Asia
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Long-term analysis of children with esophageal atresia and tracheoesophageal fistula

Abstract

Background/purpose

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

Congenital atresia of the oesophagus with tracheo-osophageal fistulaExtrapleural ligation of fistula and end-to-end anastomosis of esophageal segments

Surg Gynecol Obstet

Osophageal atresiaThe epitome of modern surgery

Ann R Coll Surg Engl

Esofagusatresia ja trakeosofageaalinen fisteli

Thesis

Analysis of morbidity and mortality in 227 cases of esophageal atresia and/or tracheoesophageal fistula over two decades

Arch Surg