Anastomotic stricture indexes for endoscopic balloon dilation after esophageal atresia repair: a single-center study

2020 ◽  
Author(s):  
Jinshi Huang ◽  
Junmin Liao ◽  
Shen Yang ◽  
Yanan Zhang ◽  
Yong Zhao ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Roc Curve ◽  
Balloon Dilatation ◽  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Curve Analysis ◽  
Medium Term ◽  
Roc Curve Analysis ◽  
Endoscopic Balloon Dilatation ◽  
Endoscopic Balloon

Summary We investigated changes in anastomotic stricture indexes (SIs) and stricture diameter (SD) between before and 6 months after the first dilatation in children with anastomotic stricture after esophageal atresia (EA) repair and identified predictors of medium-term dilatation success (success for at least 3 months). We retrospectively reviewed the records and measurement indexes of patients who underwent post-EA repair endoscopic balloon dilatation between November 2017 and August 2019 in our hospital. We identified diagnostic and performance indicators that predicted medium-term dilatation success by univariate and multivariate analyses and receiver operator characteristic (ROC) curve analysis. Sixty patients (34 boys and 26 girls) showed post-EA repair anastomotic stricture. Paired sample t-tests showed that SD (P < 0.001), upper pouch SI (U-SI, P < 0.001), lower pouch SI (L-SI, P < 0.001), upper pouch esophageal anastomotic SI (U-EASI, P < 0.001) and lower pouch EASI (L-EASI, P < 0.001) were significantly better at 6 months after than before the first dilatation. Logistic regression analysis showed that dilatation number (P = 0.002) and U-SI at 6 months after the first dilatation (P = 0.019) significantly predicted medium-term dilatation success. ROC curve analysis revealed that combining U-SI (cut-off value = 55.6%) and dilatation number (cut-off value = 10) had good accuracy in predicting medium-term dilatation success 6 months after the first dilatation (area under the curve-ROC: 0.95). In conclusion, endoscopic balloon dilatation significantly improved SD and SIs in children with post-EA repair anastomotic stricture. Dilatation number and U-SI at 6 months after the first dilatation were useful in predicting medium-term dilatation success and could represent a supplementary method to improve judgment regarding whether further dilatation is needed 6 months after the first dilatation.

Endoscopic Balloon Dilatation for Anastomotic Stricture Developed after Surgery for Colorectal Cancer

2008 ◽  
Vol 24 (1) ◽  
pp. 27
Author(s):  
Byung Nyun Kim ◽  
Dae Kyung Sohn ◽  
Chang Won Hong ◽  
Kyung Su Han ◽  
Dong Hyun Choi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Balloon Dilatation ◽  
Anastomotic Stricture ◽  
Endoscopic Balloon Dilatation ◽  
Endoscopic Balloon

Utility of repeated therapeutic endoscopies for pediatric esophageal anastomotic strictures

2020 ◽  
Vol 33 (12) ◽  
Author(s):  
Jessica L Yasuda ◽  
Gabriela N Taslitsky ◽  
Steven J Staffa ◽  
Susannah J Clark ◽  
Peter D Ngo ◽  
...  
Keyword(s):  
Roc Curve ◽  
Endoscopic Therapy ◽  
Balloon Dilation ◽  
Curve Analysis ◽  
Esophageal Leak ◽  
Roc Curve Analysis ◽  
Post Surgery ◽  
Initial Surgery ◽  
Anastomotic Strictures ◽  
History Of

Summary Anastomotic stricture is a common complication of esophageal atresia (EA) repair. Such strictures are managed with dilation or other therapeutic endoscopic techniques such as steroid injections, stenting, or endoscopic incisional therapy (EIT). In situations where endoscopic therapy is unsuccessful, patients with refractory strictures may require surgical stricture resection; however, the point at which endoscopic therapy should be abandoned in favor of repeat thoracotomy is unclear. We hypothesized that increasing numbers of therapeutic endoscopies are associated with increased likelihood of stricture resection. We retrospectively reviewed the records of patients with EA who had an initial surgery at our institution resulting in an esophago-esophageal anastomosis between August 2005 and May 2019. Up to 2 years of post-surgery endoscopy data were collected, including exposure to balloon dilation, intralesional steroid injection, stenting, and EIT. Primary outcome was need for stricture resection. Receiver operating characteristic (ROC) curve analysis and univariate and multivariable Cox proportional hazards regression analyses were performed. There were 171 patients who met inclusion criteria. The number of therapeutic endoscopies was a moderate predictor of stricture resection by ROC curve analysis (AUC = 0.720, 95% CI 0.617–0.823). With increasing number of therapeutic endoscopies, the probability of remaining free from stricture resection decreased. By Youden’s J index, a cutoff of ≥7 therapeutic endoscopies was optimal for discriminating between patients who had versus did not have stricture resection, though an absolute majority of patients (≥50%) remained free of stricture resection at each number of therapeutic endoscopies through 12 endoscopies. Significant predictors of needing stricture resection by univariate regression included ≥7 therapeutic endoscopies, Foker surgery for long-gap EA, fundoplication, history of esophageal leak, and length of stricture ≥10 mm. Multivariate analysis identified only history of leak as statistically significant, though this regression was underpowered. The utility of repeated therapeutic endoscopies may diminish with increasing numbers of endoscopic therapeutic attempts, with a cutoff of ≥7 endoscopies identified by our single-center experience as our statistically optimal discriminator between having stricture resection versus not; however, a majority of patients remained free of stricture resection well beyond 7 therapeutic endoscopies. Though retrospective, this study supports that repeated therapeutic endoscopies may have clinical utility in sparing surgical stricture resection. Esophageal leak is identified as a significant predictor of needing subsequent stricture resection. Prospective study is needed.

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