The role of fiberoptic endoscopy in the evaluation and management of long gap isolated esophageal atresia

Abstract Background In esophageal atresia (EA) patients, cumulative risk of having a fundoplication ranges from 0% to 45%, with long gap patients with recurrent strictures at even higher risk. However, there are no controlled trials evaluating the outcomes postfundoplication. We hypothesized that children with EA undergoing fundoplication will suffer from more postoperative dysphagia compared to non-EA patients as the fundoplication increases the resistance to esophageal bolus flow, which is already hampered by abnormal motility. Aims Our study aimed to compare outcomes in EA patients with age- and sex-matched control patients postfundoplication. Methods This was an international multicenter retrospective cohort study. All EA patients who had fundoplication between 2006 and 2017 during this period were included. Data were also collected from age- and sex-matched children without EA who underwent fundoplication. Results A total of 40 EA patients had fundoplication during this period. Of the EA patients 82.5% were type C, and 82.5% were long gap. Table 1 compares EA patients with controls. Significantly more EA patients were failing to thrive, on nasogastric/gastrostomy feeds at time of surgery and needed gastrostomy placement at time of fundoplication compared to controls. A total of 17.5% of EA patients developed infection and 22.5% a leak postfundoplication. EA patients had postoperative dysphagia and oral aversion significantly more often than controls. Of 90% of EA patients had recurrence of gastrointestinal or respiratory symptoms, 35% had recurrent strictures, 5% had a new diagnosis of eosinophilic esophagitis postfundoplication. Median time to symptom recurrence was 64 days (12–165 days), 90% were back on PPI and 7.5% had redofundoplication. Conclusions Our study is the first to examine postfundoplication outcomes in EA patients and compare these with a matched control group. EA patients had significantly more dysphagia and oral aversion postfundoplication and majority were back on PPI within two months of surgery. Based on these data, the role of fundoplication in EA patients should be reconsidered. Prospective data are urgently needed.

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Usefulness of Gastrojejunostomy Prior to Fundoplication in Severe Gastro-Esophageal Reflux Complicating Long-Gap Esophageal Atresia Repair: A Preliminary Study

Children ◽

10.3390/children8010055 ◽

2021 ◽

Vol 8 (1) ◽

pp. 55

Author(s):

Francesca Destro ◽

Luciano Maestri ◽

Milena Meroni ◽

Federico Rebosio ◽

Giulia Del Re ◽

...

Keyword(s):

Esophageal Atresia ◽

Hospital Admissions ◽

Growth Failure ◽

Esophageal Reflux ◽

Long Gap ◽

Nutritional Conditions ◽

Significant Difference ◽

Significant Amelioration ◽

Long Gap Esophageal Atresia

Background: Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgery for GERD in LGEA. Methods: Seven infant patients operated on for LGEA with intra-thoracic gastro-esophageal junction (GEJ) and growth failure, requiring improvement in their nutritional profile in anticipation of surgery, were retrospectively evaluated. Post-surgical follow-up, including growth evolution, complications, and parental quality of life (QoL), were considered. Results: The TGJ was placed at a mean age of 8.6 ± 5.6 months. The procedure was uneventful and well-tolerated in all seven cases. At 6.6 ± 2.0 months after TGJ placement, significant weight gain (weight z-score −2.68 ± 0.8 vs −0.9 ± 0.2, p < 0.001) was recorded, allowing the GERD surgery to proceed. A significant difference in hospital admissions between 3 months before and post-TGJ insertion was noted (4.8 ± 0.75 vs. 1.6 ± 0.52, p < 0.01). A significant amelioration of QoL after TGJ placement was also recorded; in particular, the biggest improvements were related to parents’ perceptions of the general health and emotional state of their babies (p < 0.001). Conclusions: The placement of TGJ as a temporary nutritional tool in selected cases of LGEA could improve nutritional conditions and parental QoL before fundoplication, allowing successful surgical treatment of GERD to be carried out.

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O-04 (16:41 to 16:53): The Role of Major Flap in Case of Long Gap Esophageal Atresia

Diseases of the Esophagus ◽

10.1093/dote/29.3.286 ◽

2016 ◽

Vol 29 (3) ◽

pp. 286-286

Author(s):

L. Valfre ◽

A. Conforti ◽

B.D. Iacobelli ◽

F. Fusaro ◽

F. Morini ◽

...

Keyword(s):

Esophageal Atresia ◽

Long Gap ◽

Long Gap Esophageal Atresia

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Treatment of Ultra Long-Gap Esophageal Atresia. Own Experience based on Combined Foker and Kimura Technique

Polish Journal of Surgery ◽

10.2478/v10035-009-0018-9 ◽

2009 ◽

Vol 81 (3) ◽

Author(s):

Mariusz Sroka ◽

Piotr Czauderna ◽

Piotr Landowski

Keyword(s):

Esophageal Atresia ◽

Long Gap ◽

Long Gap Esophageal Atresia

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Clinically Relevant Tracheomalacia after Repair of Esophageal Atresia: the Role of Minimal Intra-Operative Dissection and Timing for Aortopexy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2005-872954 ◽

2006 ◽

Vol 54 (03) ◽

pp. 178-181 ◽

Cited By ~ 4

Author(s):

A. Dodge-Khatami ◽

D. Deanovic ◽

P. Sacher ◽

M. Weiss ◽

A. Gerber

Keyword(s):

Esophageal Atresia

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Delayed presentation of tracheomalacia in an infant with long-gap esophageal atresia and distal tracheoesophageal fistula and a right aortic arch

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2006.07.009 ◽

2006 ◽

Vol 41 (10) ◽

pp. 1788-1790 ◽

Cited By ~ 2

Author(s):

Gin Peh ◽

Peter Chow ◽

Munter Haddad ◽

Sunit Godambe

Keyword(s):

Aortic Arch ◽

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

Right Aortic Arch ◽

Delayed Presentation ◽

Long Gap ◽

Long Gap Esophageal Atresia

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DOZ047.124: Thoracoscopic anatomy of long-gap esophageal atresia. What can we predict?

Diseases of the Esophagus ◽

10.1093/dote/doz047.124 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

M Rasiewicz ◽

K Świątek ◽

S Gerus ◽

D Patkowski

Keyword(s):

Esophageal Atresia ◽

Gold Standard ◽

Distal Stump ◽

Thoracic Vertebrae ◽

Long Gap ◽

Thoracoscopic Repair ◽

Proximal Stump ◽

Long Gap Esophageal Atresia ◽

Vertebral Bodies ◽

Traction Group

Abstract Since the very beginning in 1999, thoracoscopic repair of esophageal atresia has become a gold standard in many pediatric surgery centers worldwide. Despite the advances in surgical technique, treatment of long-gap esophageal atresia still remains a challenge. The aim of this study is to assess whether the localization of esophageal stumps can predict number of stages needed to perform anastomosis. We analyzed video records of 21 patients who underwent staged thoracoscopic repair of long-gap esophageal atresia using internal traction technique. All procedures were performed by the same surgeon. We divided patients into two groups: first requiring single internal traction procedure, second who underwent multiple procedures. We assessed esophageal stump position in relation to thoracic vertebrae. The distance between stumps was measured in vertebral bodies. Mean distance between esophageal ends was 5.8 in single traction group. The distance between the stumps was significantly greater in multiple procedures group: 7.33 (P = 0.003). Patients who required multiple procedures had significantly lower localization of distal stump. Localization of proximal stump did not affect the possibility for anastomosis after single traction. Distance between both ends after internal traction was also significantly longer in multiple procedures group. Patients with lower localization of distal esophageal stump assessed during primary thoracoscopy are at higher risk for requiring multiple surgical procedures.

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