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The management of postoperative reflux in congenital esophageal atresia–tracheoesophageal fistula: a systematic review

Pediatric Surgery International volume 30, pages 987–996 (2014)Cite this article

Abstract

Purpose

Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is associated with postoperative gastroesophageal reflux (GER). We performed a systematic review of the literature regarding routine anti-reflux medication post EA-TEF repair and its impact on postoperative GER and associated complications.

Methods

A comprehensive search was conducted using MEDLINE, EMBASE, CINHAL, CENTRAL (Cochrane library) electronic databases and gray literature. Full-text screening was performed in duplicate. Included articles reported a primary diagnosis of EA-TEF, a secondary diagnosis of postoperative GER, and primary treatment of GER with anti-reflux medications.

Results

Screening of 2,910 articles resulted in 25 articles (1,663 patients) for analysis. Most were single-center studies (92 %) and retrospective (76 %); there were no randomized control trials. Fifteen studies named the class of anti-reflux agent used, 3 the duration of therapy, and none either the dose prescribed or number of doses. Complications were inconsistently reported. Anti-reflux surgery was performed in 433/1,663 (26.0 %) patients. Average follow-up was 53.2 months (14 studies).

Conclusion

The quality of literature regarding anti-reflux medication for GER post EA-TEF repair is poor. There are no well-outlined algorithms for anti-reflux agents, doses, or duration of therapy. Standardized protocols and reliable reporting are necessary to develop guidelines to better manage postoperative GER in EA-TEF patients.

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Acknowledgements

The authors would like to thank David Kanters and Jorge Zequeira for their assistance with data management, and Janet Rowe for her assistance with editing the manuscript.

Conflict of interest

None.

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Affiliations

  1. Department of Pediatric Surgery, McMaster Children’s Hospital, Hamilton, ON, Canada

    Anna C. Shawyer, Julia Pemberton & Helene Flageole

  2. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Joanne D’Souza

  3. McMaster Pediatric Surgery Research Collaborative, McMaster Children’s Hospital, Hamilton, ON, Canada

    Anna C. Shawyer, Julia Pemberton & Helene Flageole

Authors
  1. Anna C. Shawyer
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  2. Joanne D’Souza
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  3. Julia Pemberton
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  4. Helene Flageole
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Correspondence to Anna C. Shawyer.

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Shawyer, A.C., D’Souza, J., Pemberton, J. et al. The management of postoperative reflux in congenital esophageal atresia–tracheoesophageal fistula: a systematic review. Pediatr Surg Int 30, 987–996 (2014). https://doi.org/10.1007/s00383-014-3548-0

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Keywords

  • Esophageal atresia
  • Tracheoesophageal fistula
  • Gastroesophageal reflux
  • Postoperative management