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Anastomotic strictures and endoscopic dilatations following esophageal atresia repair

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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.

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Abbreviations

AS:

Anastomotic strictures

EA:

Esophageal atresia

HR:

Hazard ratio

SD:

Standard deviation

SI:

Stricture index

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Acknowledgments

No funding was necessary for this study.

Conflict of interest

The authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. Department of Paediatric Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Padiglione Alfieri (Chirurgia Pediatrica), Via Commenda, 10, 20122, Milan, Italy

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

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  1. Filippo Parolini
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  2. Ernesto Leva
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  3. Anna Morandi
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  4. Francesco Macchini
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  5. Valerio Gentilino
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  6. Antonio Di Cesare
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  7. Maurizio Torricelli
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Correspondence to Filippo Parolini.

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Parolini, F., Leva, E., Morandi, A. et al. Anastomotic strictures and endoscopic dilatations following esophageal atresia repair. Pediatr Surg Int 29, 601–605 (2013). https://doi.org/10.1007/s00383-013-3298-4

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  • DOI: https://doi.org/10.1007/s00383-013-3298-4

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