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Predictive factors affecting the prognosis and late complications of 73 consecutive cases of esophageal atresia at 2 centers

  • Ryuta Masuya
  • Tatsuru Kaji
  • Motoi Mukai
  • Kazuhiko Nakame
  • Takafumi Kawano
  • Seiro Machigashira
  • Waka Yamada
  • Koji Yamada
  • Shun Onishi
  • Keisuke Yano
  • Tomoe Moriguchi
  • Koshiro Sugita
  • Masato Kawano
  • Hiroyuki Noguchi
  • Masaya Suzuhigashi
  • Mitsuru Muto
  • Satoshi Ieiri
Original Article
  • 36 Downloads

Abstract

Purpose

While the diagnosis and outcomes of esophageal atresia (EA) have improved, associated anomalies, the management of late complications and growth remain major issues. We analyzed factors that affected the prognosis, late complications and growth.

Methods

We retrospectively reviewed EA patients treated at two centers from 1984 to 2016. Patient characteristics, complications (gastroesophageal reflux [GER], anastomotic stenosis, tracheomalacia, dysphagia) and growth were evaluated.

Results

Seventy-three EA patients were treated (overall survival rate:80.8%). The mean birth weight was 2514 ± 509 g in the surviving group, and 2453 ± 567 g in the fatal group excluded chromosomal abnormality (p = 0.76). Cardiac and chromosomal anomalies significantly affected mortality. Postoperative GER and anastomotic stenosis each occurred in 39% of the patients. Only GER was significantly affected by the Gross classification. The standard deviation (SD) values of the EA patients’ growth were all lower than in the normal population. The SD of body weight was significantly lower in patients with extremity anomalies.

Conclusions

Associated cardiac and chromosomal anomalies significantly affected the prognosis. GER and anastomotic stenosis were the most common late complications. The growth of the surviving cases was insufficient. These factors will help optimize the therapeutic strategies and postoperative management for EA.

Keywords

Esophageal atresia Mortality Morbidity Growth Late complication GER 

Notes

Acknowledgements

We thank Mr. Brian Quinn for his comments and help with the manuscript. This study was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS, Nos. 26670765, 16K10466, 16K10094, 16K10095, 16K10434, 16H07090, 17K10555, 17K11514, 17K10183, 17K11515), a research grant from the President’s Discretionary Expenses of our university, and a research grant from The UBE Foundation.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

References

  1. 1.
    Waterston D, Carter RB, Aberdeen E (1962) Oesophageal atresia: tracheo-oesophageal fistula: a study of survival in 218 infants. Lancet 279(7234):819–822CrossRefGoogle Scholar
  2. 2.
    Spitz L, Kiely EM, Morecroft JA, Drake DP (1994) Oesophageal atresia: at-risk groups for the 1990s. J Pediatr Surg 29(6):723–725CrossRefPubMedGoogle Scholar
  3. 3.
    Choudhury SR, Ashcraft KW, Sharp RJ, Murphy JP, Snyder CL, Sigalet DL (1999) Survival of patients with esophageal atresia: influence of birth weight, cardiac anomaly, and late respiratory complications. J Pediatr Surg 34(1):70–74CrossRefPubMedGoogle Scholar
  4. 4.
    Beasley SW, Myers NA (1992) Trends in mortality in oesophageal atresia. Pediatr Surg Int 7(2):86–89CrossRefGoogle Scholar
  5. 5.
    Wang B, Tashiro J, Allan BJ, Sola JE, Parikh PP, Hogan AR et al (2014) A nationwide analysis of clinical outcomes among newborns with esophageal atresia and tracheoesophageal fistulas in the United States. J Surg Res 190(2):604–612CrossRefPubMedGoogle Scholar
  6. 6.
    Deurloo JA, Ekkelkamp S, Schoorl M, Heij HA, Aronson DC (2002) Esophageal atresia: historical evolution of management and results in 371 patients. Ann Thorac Surg 73(1):267–272CrossRefPubMedGoogle Scholar
  7. 7.
    Okamoto T, Takamizawa S, Arai H, Bitoh Y, Nakao M, Yokoi A et al (2009) Esophageal atresia: prognostic classification revisited. Surgery 145(6):675–681CrossRefPubMedGoogle Scholar
  8. 8.
    Cassina M (2016) Prevalence, characteristics, and survival of children with esophageal atresia: a 32-year population-based study including 1,417,724 consecutive newborns Survival for Children with Esophageal Atresia. Birth Defects Res A 106(7):542–548CrossRefGoogle Scholar
  9. 9.
    Beasley S, Allen M, Myers N (1997) The effects of Down syndrome and other chromosomal abnormalities on survival and management in oesophageal atresia. Pediatr Surg Int 12(8):550–551CrossRefPubMedGoogle Scholar
  10. 10.
    Shawyer AC, Pemberton J, Kanters D, Alnaqi AA, Flageole H (2015) Quality of reporting of the literature on gastrointestinal reflux after repair of esophageal atresia- tracheoesophageal fistula. J Pediatr Surg 50(7):1099–1103CrossRefPubMedGoogle Scholar
  11. 11.
    Yanchar NL, Gordon R, Cooper M, Dunlap H, Soucy P (2001) Significance of the clinical course and early upper gastrointestinal studies in predicting complications associated with repair of esophageal atresia. J Pediatr Surg 36(5):815–822CrossRefPubMedGoogle Scholar
  12. 12.
    Montedonico S, Diez-Pardo JA, Possogel AK, Tovar JA (1999) Effects of esophageal shortening on the gastroesophageal barrier: an experimental study on the causes of reflux in esophageal atresia. J Pediatr Surg 34(2):300–303CrossRefPubMedGoogle Scholar
  13. 13.
    Kawahara H, Kubota A, Hasegawa T, Okuyama H, Ueno T, Watanabe T et al (2007) Lack of distal esophageal contractions is a key determinant of gastroesophageal reflux disease after repair of esophageal atresia. J Pediatr Surg 42(12):2017–2021CrossRefPubMedGoogle Scholar
  14. 14.
    Baird R, Laberge J-M, Lévesque D (2013) Anastomotic stricture after esophageal atresia repair: a critical review of recent literature. Eur J Pediatr Surg 23(03):204–213CrossRefPubMedGoogle Scholar
  15. 15.
    Vukadin M, Savic D, Malikovic A, Jovanovic D, Milickovic M, Bosnic S et al (2015) Analysis of prognostic factors and mortality in children with esophageal atresia. Indian J Pediatr 82(7):586–590CrossRefPubMedGoogle Scholar
  16. 16.
    Spitz L, Kiely E, Brereton RJ (1987) Esophageal atresia: Five year experience with 148 cases. J Pediatr Surg 22(2):103–108CrossRefPubMedGoogle Scholar
  17. 17.
    Slany E, Holzki J, Holschneider AM, Gharib M, Hugel W, Mennicken U (1990) [Tracheal instability in tracheo-esophageal abnormalities]. Z Kinderch 45(2):78–85Google Scholar
  18. 18.
    Dave S, Currie BG (2006) The role of aortopexy in severe tracheomalacia. J Pediatr Surg 41(3):533–537CrossRefPubMedGoogle Scholar
  19. 19.
    Engum SA, Grosfeld JL, West KW, Rescorla FJ, Scherer LR 3rd (1995) Analysis of morbidity and mortality in 227 cases of esophageal atresia and/or tracheoesophageal fistula over two decades. Arch Surg 130(5):502–508CrossRefPubMedGoogle Scholar
  20. 20.
    Krishnan U, Mousa H, Dall’Oglio L, Homaira N, Rosen R, Faure C et al (2016) ESPGHAN-NASPGHAN guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with esophageal atresia–tracheoesophageal fistula. J Pediatr Gastr Nutr 63(5):550–570CrossRefGoogle Scholar
  21. 21.
    Little DC, Rescorla FJ, Grosfeld JL, West KW, Scherer LR, Engum SA (2003) Long-term analysis of children with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 38(6):852–856CrossRefPubMedGoogle Scholar
  22. 22.
    Gischler SJ, van der Cammen-van Zijp MHM, Mazer P, Madern GC, Bax NMA, de Jongste JC et al (2009) A prospective comparative evaluation of persistent respiratory morbidity in esophageal atresia and congenital diaphragmatic hernia survivors. J Pediatr Surg 44(9):1683–1690CrossRefPubMedGoogle Scholar
  23. 23.
    Presse N, Taillefer J, Maynard S, Bouin M (2016) Insufficient body weight of adults born with esophageal atresia. J Pediatr Gastr Nutr 62(3):469–473CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ryuta Masuya
    • 1
  • Tatsuru Kaji
    • 1
  • Motoi Mukai
    • 1
  • Kazuhiko Nakame
    • 1
  • Takafumi Kawano
    • 1
  • Seiro Machigashira
    • 1
  • Waka Yamada
    • 1
  • Koji Yamada
    • 1
  • Shun Onishi
    • 1
  • Keisuke Yano
    • 1
  • Tomoe Moriguchi
    • 1
  • Koshiro Sugita
    • 1
  • Masato Kawano
    • 1
  • Hiroyuki Noguchi
    • 2
  • Masaya Suzuhigashi
    • 2
  • Mitsuru Muto
    • 2
  • Satoshi Ieiri
    • 1
  1. 1.Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education AssemblyKagoshima UniversityKagoshimaJapan
  2. 2.Department of Pediatric SurgeryKagoshima City HospitalKagoshimaJapan

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