Anastomotic Strictures after Esophageal Atresia Repair: Timing of Dilatation during the First Two Postoperative Years

Background We determined time frames for dilatation of anastomotic strictures (ASs) occurring during the first 2 years after esophageal atresia (EA) repair. Methods A retrospective study was conducted on children with EA (Gross type C) who underwent direct repair between January 2008 and March 2015 at a single tertiary center of pediatric surgery. Endoscopic signs of stricture were indications for dilatation because the endoscopy provides more reliable information than X-ray imagining methods. Results Among our cohort of 49 children with EA, 19 (39%) required at least one esophageal dilatation. All children required initial dilatation within the first year of life and none was older than 1 year during initial dilatation (p < 0.01). A median of three dilatations (range: 1–13) took place per patient, with 87% performed during the first postoperative year. The timing of initial dilatation in the first year (< 6 months, 14/19 [74%] vs. 6–12 months, 5/19 [26%]) was predictive of the need for dilatation beyond the first year (9/14 [64%] vs. 0/5 [0%]; p = 0.03) but not of more numerous dilatations (median, 3 vs. 1; p = 0.07). Conclusion The need for dilatation within 6 months postoperatively predicts the need for dilatation after 1 year, but it does not indicate the number of dilatations that will be needed.

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Congenital Heart Disease and Its Impact on the Development of Anastomotic Strictures after Reconstruction of Esophageal Atresia

Gastroenterology Research and Practice ◽

10.1155/2018/6021014 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Pernilla Stenström ◽

Martin Salö ◽

Magnus Anderberg ◽

Einar Arnbjörnsson

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Esophageal Atresia ◽

Congenital Heart ◽

First Year ◽

Retrospective Case ◽

Anastomotic Strictures ◽

First Year Of Life ◽

Severe Congenital Heart Disease

Background. The aim was to explore if severe congenital heart disease (CHD) influenced the need for dilatation of anastomotic strictures (AS) after the repair of esophageal atresia (EA). Methods. A retrospective case-control study was conducted examining AS in children with EA and Gross type C. The spectra of CHD and cardiac interventions were reviewed. The frequency of dilatations of AS during the first year following EA reconstruction was compared between children with and without severe CHD requiring cardiac surgery during their first year of life. Endoscopic signs of stricture were an indication for dilatation. Results. Included in the follow-up for AS were 94 patients who had EA reconstructions, of whom 10 (11%) children had severe CHD requiring surgery during the first year including 19 different cardiac interventions. In total, 38 patients needed dilatation of esophageal AS, distributed as six (60%) with severe CHD and 32 (38%) without severe CHD (p=0.31). Conclusion. Severe CHD was present in 11% of children with EA. Esophageal AS developed in 60% children with concomitant CHD, but although high, it did not reach statistical difference from children without CHD (38%).

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DOZ047.92: Oesophageal atresia: a multicenter retrospective study on surgical treatment and 1-year follow-up

Diseases of the Esophagus ◽

10.1093/dote/doz047.92 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

C Vercauteren ◽

H Reusens ◽

A De Backer ◽

R Tambucci ◽

S Van Cauwenberge ◽

...

Keyword(s):

Retrospective Study ◽

Oesophageal Atresia ◽

Tube Placement ◽

First Year ◽

Paediatric Surgery ◽

Anastomotic Strictures ◽

Associated Malformations ◽

Type C ◽

First Year Of Life

Abstract Introduction No data are available on surgical management and outcomes of oesophageal atresia (OA) in Belgium. In collaboration with the Belgian Association of Paediatric Surgery (BELAPS) a retrospective study was organized to analyze data from children born with OA, with a 1-year follow-up. Materials and Methods Out of 17 centers in Belgium, 10 participated in this study. A novel checklist to collect data from OA patients born between the 1st of January 2010 and the 1st of January 2015 was created. Gross type A, B, C and D OA were included. Results One hundred children were included. Gross type C OA was seen in 86%. Associated malformations were present in 73%, most frequently cardiac malformations (52%). There was consensus regarding preoperative investigations, anastomotic technique, and transanastomotic tube placement. There was no consensus regarding genetic counseling, placement of a chest tube, and start of enteral feeding. There were six deaths in the first year of life. The majority of patients needed rehospitalization during the first year of life (85.9%) and there was a high occurrence of anastomotic strictures (51.6%). Conclusions This is the first study about management and outcome of OA in Belgium. Although the 1-year survival rate is high (93.8%), these data illustrate that OA has an important morbidity. Multidisciplinary follow-up and prospective studies/registries with longer follow-up are needed.

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A NOMOGRAM FOR THE X-RAY EVALUATION OF SOME MORPHOLOGICAL ANOMALIES OF THE PELVIS IN THE DIAGNOSIS OF MONGOLISM

PEDIATRICS ◽

10.1542/peds.32.6.1074 ◽

1963 ◽

Vol 32 (6) ◽

pp. 1074-1077

Author(s):

F. B. Nicolis ◽

G. Sacchetti

Keyword(s):

Quantitative Estimation ◽

Numerical Calculations ◽

First Year ◽

Discriminant Functions ◽

Normal Children ◽

X Ray ◽

Morphological Anomalies ◽

First Year Of Life

Some morphological anomalies of the pelvis were radiologically evaluated in 25 mongoloid children within the first year of life, in comparison with 45 normal children, through the measurements of the acetabular and iliac angles. The results were statistically analyzed according to the model of discriminant functions, and the combination of the two measurements which gives the best discrimination between mongoloid and normal children was established; on this basis, a nomogram is presented, where-by a quantitative estimation of the morphological anomalies can be made, for diagnostic purposes, without numerical calculations and with a low error.

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Outcome of esophageal atresia in Germany

Diseases of the Esophagus ◽

10.1093/dote/doaa093 ◽

2020 ◽

Author(s):

A Schmedding ◽

B Wittekindt ◽

R Schloesser ◽

M Hutter ◽

U Rolle

Keyword(s):

Mortality Rate ◽

Esophageal Atresia ◽

First Year ◽

Insurance Company ◽

Associated Anomalies ◽

Clinical Registry ◽

Major Health ◽

First Year Of Life ◽

Overall Mortality

Abstract The aim of this study was to evaluate the outcome of esophageal atresia in Germany in a retrospective observational study of a large cohort. Data from the major health insurance company in Germany, which covers approximately 30% of German patients, were analyzed. All patients born and registered between 2009 and 2013 with a diagnosis of esophageal atresia at first admission to the hospital were included. Mortality was analyzed during the first year of life. We identified 287 patients with esophageal atresia, including 253 with and 34 without tracheoesophageal fistula. Associated anomalies were found in 53.7% of the patients; the most frequent were cardiac anomalies (41.8%), anomalies of the urinary tract (17.4%), and atresia of the colon, rectum, and anus (9.4%). Forty-one patients (14.3%) had a birth weight <1500 g. Seventeen patients (5.9%) died before surgery. Gastrostomy was performed during the index admission in 70 patients (25.9%). The reconstruction of the esophageal passage was performed in 247 patients (93.9%). Forty-eight percent of the patients who underwent an operation required dilatation. The mortality rate in the patients who underwent an operation was 10.4%. These results from Germany correspond to the international results that have been reported. The number of dilatations was in the middle of the range of those reported in the literature; the overall mortality rate was in the upper portion of the range of the international rates. Efforts should be made to establish a clinical registry to measure and improve the quality of care for this and other rare conditions.

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Neurodevelopmental outcome in infants with esophageal atresia: risk factors in the first year of life

Diseases of the Esophagus ◽

10.1093/dote/doaa102 ◽

2020 ◽

Author(s):

Bevilacqua Francesca ◽

Ragni Benedetta ◽

Conforti Andrea ◽

Braguglia Annabella ◽

Gentile Simonetta ◽

...

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Cognitive Development ◽

Low Birth Weight ◽

Multiple Regression ◽

Esophageal Atresia ◽

Gestational Age ◽

Motor Development ◽

First Year ◽

First Year Of Life

Summary Data on neurodevelopmental outcomes of infants born with esophageal atresia (EA) are still scarce and controversial. The aims of our study were to evaluate motor and cognitive development during the first year of life, in patients operated on of EA and to investigate potential risk factors for motor and cognitive development both at 6 and 12 months. This is an observational prospective longitudinal study in a selected cohort of type C and D EA infants enrolled in our follow-up program from 2009 to 2017. In order to exclude possible confounding factors, the following exclusion criteria were applied: (i) gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g; (ii) genetic syndrome or chromosomal anomaly known to be associated with neurodevelopmental delay; (iii) neurologic disease; (iv) esophageal gap ≥three vertebral bodies. Patients were evaluated at 6 and 12 months of life (corrected age for infants with a gestational age of 32–37 weeks) with the Bayley Scales of Infant and Toddler Development—3rd Edition. In our selected cohort of EA infants, 82 were evaluated at 6 months and 59 were reevaluated at 12 months. Both Motor and Cognitive average scores were within the norm at both time points. However, we report increased number of infants with motor delay with time: 14% at 6 months and 24% at 12 months. Multiple regression analysis for Motor scores at 6 [F(4,74) = 4.363, P = 0.003] and 12 months [F(6,50) = 2.634, P = 0.027] identified (i) low birth weight, (ii) longer hospital stay and (iii) weight < fifth percentile at 1 year as risk factors. Interestingly, average Cognitive scores also increased with time from 85.2% at 6 months and 96.6% at 12 months. Multiple regression models explaining variance of Cognitive scores at 6 [F(4, 73) = 2.458, P = 0.053] and 12 months [F(6, 49) = 1.232, P = 0.306] were nonsignificant. Our selected cohort of EA patients shows, on the average, Motor and Cognitive scores within the norm both at 6 and 12 months. Nevertheless, the percentage of infants with Motor scores below the average increases regardless gestational age. None of clinical and sociodemographic variables taken into consideration was able to predict cognitive development both at 6 and 12 months whereas risk factors for Motor development change during the first year of life. Healthcare providers should pay particular attention to patients with low birth weight, longer hospital stays and weight under fifth percentile at 1 year. Future studies should include long-term outcomes to reveal possible catch up in motor development and/or possible findings in Cognitive scores.

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Esophageal Interventions in Infants Born with Esophageal Atresia: A Comprehensive Analysis of a National Database

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1739415 ◽

2021 ◽

Author(s):

Tatjana T. König ◽

Emilio Gianicolo ◽

Luisa Frankenbach ◽

Eva Wittenmeier ◽

Oliver J. Muensterer

Keyword(s):

Esophageal Atresia ◽

Primary Anastomosis ◽

Treatment Strategies ◽

Primary Treatment ◽

National Database ◽

First Year ◽

Rare Malformation ◽

Low Incidence ◽

First Year Of Life ◽

And Training

Abstract Introduction Esophageal atresia (EA) is a rare malformation that often requires a series of procedures, including surgical primary anastomosis, staged repair, and endoscopic procedures. Actual numbers and trends in interventions and variety in treatment strategies remain unclear. Materials and Methods Data from the German federal bureau of statistics containing all EA-related inpatient procedures encoded from 2005 until 2018 were analyzed for children during the first year of life. The sum of esophageal anastomoses and replacements was used to calculate an estimate of incidence of EA. Results Over 14 years, 12,627,888 inpatient cases were recorded in infants in Germany. The mean incidence of EA was 1 per 4,217 live births. On average, 163.3 (95% confidence interval [CI]: 150.8–176.1) esophageal anastomoses, 11.2 (95% CI: 8.7–13.7) esophageal lengthening procedures, and 6.7 (95% CI: 5.42–8.00) esophageal replacements were recorded annually. Overall, 187.8 (95% CI: 147.1–200.4) endoluminal treatments (ballon dilatation, bougienage, stent placement, or injection) were performed per 100 anastomoses. Over the years, bougienage was increasingly replaced by ballon dilatation as primary treatment. Boys had a significantly higher number of esophageal procedures than girls, but the incidence of endoscopic treatments in relation to anastomoses was the same for both genders. Conclusion The low incidence of EA in relation to a relatively large number of units treating those patients in Germany may pose challenges for maintaining competency and training of all specialists involved. The number of esophagoscopic treatments for esophageal stricture per anastomosis is lower than previously estimated.

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DOZ047.73: Endoscopic treatment of esophageal atresia

Diseases of the Esophagus ◽

10.1093/dote/doz047.73 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

T Vogiatzoglou ◽

S Arrigo ◽

P Gandullia

Keyword(s):

Esophageal Atresia ◽

Endoscopic Treatment ◽

Anastomotic Stricture ◽

Symptom Relief ◽

Balloon Catheter ◽

Therapeutic Endoscopy ◽

Upper Gastrointestinal Endoscopy ◽

Anastomotic Strictures ◽

Tertiary Center ◽

Therapeutic Alternatives

Abstract Aim of the Study The aim of this study was to provide an overview of endoscopic treatment in children after reconstruction of esophageal atresia. Methods This study, conducted at a single tertiary center, reviewed patients requiring endoscopic treatment during a 15-year period, from 2004 to 2018. Collected data include number, frequency, complications, and effectiveness of esophageal anastomotic dilations. Results A total of 55 children with esophageal atresia (EA) underwent upper gastrointestinal endoscopy. Of those, 37 required therapeutic endoscopy with dilation procedures for anastomotic strictures. Thirty-five patients underwent dilations using only through-the-scope (TTS) balloon (BD),1 patient using only a Savary bougie (SB), and 1 using both. A total of 126 dilations were performed using BD in 36 patients and 6 dilations using SB in 2 patients. Specifically, in children treated only with BD were performed 1 dilation in 6 children (17.1%), 2 in 6 children (17.1%), 3 in 7 children (20%), 4 in 6 children (17.1%), 5 in 6 children (17.1%), 7 in 2 children (5.7%), and 8 in 2 children (5.7%). Balloon catheter sizes ranged from 6 mm to 15 mm. In 2 patients (5.4%) stents were placed, 1 and 6 stents, respectively. Intralesional triamcinolone was injected in 8 patients (21.6%) as additional therapy. Major complications included perforation in 4 patients (10,8%), resolved with conservative treatment. All patients had clinical improvement in the follow-up. Conclusion Currently, endoscopic treatment for esophageal anastomotic stricture is the first procedure adopted in clinical practice after the surgical approach, since it is regarded safe and effective. Balloon dilations are preferred in our overview as a treatment option for esophageal anastomotic strictures. Symptom relief is reported in all cases, while the rate of complications is very low. Sometimes, refractory strictures influence the patient's quality of life and therapeutic alternatives such as stent placement should be considered.

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Treatment and Outcome for Children with Esophageal Atresia from a Gender Perspective

Surgery Research and Practice ◽

10.1155/2017/8345798 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Julia Ekselius ◽

Martin Salö ◽

Einar Arnbjörnsson ◽

Pernilla Stenström

Keyword(s):

Esophageal Atresia ◽

Pediatric Surgery ◽

Ductus Arteriosus ◽

Levels Of Care ◽

Tertiary Center ◽

Gender Specific Differences ◽

Gender Specific ◽

Different Levels ◽

Patent Ductus

Background. Besides the incidence of esophageal atresia (EA) being higher in males, no other gender-specific differences in EA have been reported. The aim of this study was to search for gender-specific differences in EA. Methods. A retrospective study was conducted at a tertiary center for pediatric surgery. The medical charts of infants born with EA were reviewed. 20 girls were identified, and 20 boys were selected as matched controls with respect to concomitant malformations. Their treatment and outcome were evaluated. Results. Polyhydramnios was more common in pregnancies with boys, 40%, versus girls, 10%, with EA (p<0.01). In total, 36 (90%) children had patent ductus arteriosus, without any gender difference (18 and 18, resp., p=1). The distribution of days at the different levels of care was not equally distributed between boys and girls. Boys with EA had significantly more postoperative days (median 5 days) in the ward than girls (median 5 and 2 days, resp., p=0.04). No other gender-specific differences in surgical treatment, complications, or symptoms at follow-up were identified. Conclusion. Polyhydramnios appears to be more frequent in pregnancies with boys than girls with EA. In this study, boys have longer stays than girls at the pediatric surgery ward.

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Latex allergy in pediatric surgery is dependent on repeated operations in the first year of life

Journal of Pediatric Surgery ◽

10.1053/jpsu.2001.27038 ◽

2001 ◽

Vol 36 (10) ◽

pp. 1535-1539 ◽

Cited By ~ 43

Author(s):

Petra Degenhardt ◽

Sabine Golla ◽

Frederike Wahn ◽

Bodo Niggemann

Keyword(s):

Pediatric Surgery ◽

Latex Allergy ◽

First Year ◽

First Year Of Life

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A rare case of left lung agenesis in a female teenager.

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v11i4.12610 ◽

2012 ◽

Vol 11 (4) ◽

pp. 350-352

Author(s):

Md Ankan Bandyopadhyay ◽

Debabrata Saha ◽

Kaushik Saha ◽

Debraj Jash ◽

Arnab Maji ◽

...

Keyword(s):

Medical Science ◽

Left Lung ◽

Pulmonary Angiography ◽

First Year ◽

X Ray ◽

History Of ◽

Chest X Ray ◽

Lung Agenesis ◽

First Year Of Life ◽

Routine Chest

Pulmonary agenesis is a rare congenital anomaly. History of recurrent chest infection in first year of life is the presenting symptom although patient may be asymptomatic and detected on routine chest x-ray. Our patient presented with recurrent chest infections since childhood. CT scan thorax revealed absence of lung tissue on left side with mediastinal shifting and herniation of right lung to left side. Pulmonary angiography confirmed the diagnosis of left lung agenesis. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12610 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12

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