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Risk factors for digestive morbidities after esophageal atresia repair

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Esophageal atresia with/without tracheoesophageal fistula (EA/TEF) is a congenital digestive tract anomaly that represents a major therapeutic challenge. Postoperative digestive morbidities such as gastroesophageal reflux disease (GERD) and esophageal stricture are common. The aim of this study was to identify the incidence of and potential risk factors for digestive morbidities after EA/TEF repair. We retrospectively reviewed all EA/TEF patients who underwent repair at a single institution between January 1999 and December 2018, excluding patients who died prior to discharge. Patient demographics, perioperative management, and postoperative GERD and esophageal stricture rates were collected. We performed univariate and multivariate analyses to examine risk factors associated with postoperative GERD and esophageal stricture. The study enrolled 58 infants (58.6% male, 17.2% with type A EA/TEF, 62.1% with associated anomalies). Postoperative GERD occurred in 67.2% of patients and was the most common digestive morbidity. Esophageal stricture occurred in 37.9% of patients after EA/TEF repair. Multivariate analysis showed that long-gap EA/TEF and postoperative GERD were independent risk factors for esophageal stricture after repair surgery.

Conclusion: The incidence of postoperative GERD and esophageal stricture was 67.2% and 37.9%, respectively. The risk factors for postoperative esophageal stricture were long-gap EA/TEF and postoperative GERD.

What is Known:

EA/TEF is a congenital digestive tract anomaly with a high postoperative survival rate but can be complicated by many long-term morbidities.

What is New:

Long-gap EA/TEF and postoperative GERD are risk factors of anastomotic stricture after repair.

Surgeons and pediatricians should be highly experienced in managing anastomotic tension and the GERD.

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Fig. 1

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Birth weight


Congenital heart disease


Esophageal atresia with/without tracheoesophageal fistula


Gastroesophageal reflux disease


Gestational age


Mechanical ventilation


Patent ductus arteriosus


Patent foramen ovale


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The statistical analysis was supported by National Taiwan University Hospital, Hsin-Chu Branch and Yu-Han, Chang, MPH from Clinical Trial Center, National Taiwan University Hospital and Chin-Hao, Chang, PhD, from Department of Medical Research, National Taiwan University Hospital. The supplementary online figure in our article was drafted by Chun-Min, Kang, MD.

Author information

Authors and Affiliations



Hung-Chieh, Chou conceived the study. Po-Nien, Tsao, Ting-An Yen, and Chien-Yi, Chen designed the study. Yi-Hsuan, Lu collected and analyzed the data. The first draft of manuscript was written by Yi-Hsuan, Lu. All authors contributed to manuscript revisions and approved the final manuscript.

Corresponding author

Correspondence to Hung-Chieh Chou.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This research study was conducted retrospectively from data obtained for clinical purpose. The Institutional Review Board of the National Taiwan University Hospital approved this study (NTUH 201901076 RINC).

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Communicated by Daniele De Luca

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Electronic supplementary material

Supplementary online Fig. 1

Types of esophageal atresia with/without tracheoesophageal fistula (EA/TEF) Listed to gross classification. Type A is isolated EA. Type B is EA with a proximal fistula connecting the upper pouch of the esophagus and the trachea. Type C is EA with a distal fistula connecting the lower pouch of the esophagus and the trachea. Type D involves both fistulae connecting the upper/lower pouch and the trachea. Type E or H TEF involves a fistula connecting the esophagus and the trachea without EA. (PNG 12327 kb)

High Resolution (TIF 152713 kb)

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Lu, YH., Yen, TA., Chen, CY. et al. Risk factors for digestive morbidities after esophageal atresia repair. Eur J Pediatr 180, 187–194 (2021).

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