Immediate and long-term outcome in operated esophageal atresia

Summary Background Although the survival rate of esophageal atresia (EA) has increased to over 90%, the risk of functional long-term neurodevelopmental deficits is uncertain. Studies on long-term outcomes of children with EA show conflicting results. Therefore, we provide an overview of the current knowledge on the long-term neurodevelopmental outcome of children with EA. Methods We performed a structured literature search in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google scholar on November 8, 2020 with the keywords ‘esophageal atresia’, ‘long-term outcome’, ‘motor development’, ‘cognitive development’, and ‘neurodevelopment’. Results The initial search identified 945 studies, of which 15 were included. Five of these published outcomes of multiple tests or tested at multiple ages. Regarding infants, one of six studies found impaired neurodevelopment at 1 year of age. Regarding preschoolers, two of five studies found impaired neurodevelopment; the one study assessing cognitive development found normal cognitive outcome. Both studies on motor function reported impairment. Regarding school-agers, the one study on neurodevelopmental outcome reported impairment. Cognitive impairment was found in two out of four studies, and motor function was impaired in both studies studying motor function. Conclusions Long-term neurodevelopment of children born with EA has been assessed with various instruments, with contrasting results. Impairments were mostly found in motor function, but also in cognitive performance. Generally, the long-term outcome of these children is reason for concern. Structured, multidisciplinary long-term follow-up programs for children born with EA would allow to timely detect neurodevelopmental impairments and to intervene, if necessary.

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Early and Long Term Outcome in Children with Esophageal Atresia Treated Over the Last 22 Years

Klinische Pädiatrie ◽

10.1055/s-0030-1249610 ◽

2010 ◽

Vol 222 (05) ◽

pp. 296-301 ◽

Cited By ~ 40

Author(s):

M. Lacher ◽

S. Froehlich ◽

D. von Schweinitz ◽

H. G. Dietz

Keyword(s):

Esophageal Atresia ◽

Term Outcome ◽

Long Term Outcome

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Publication Trends and Global Collaborations on Esophageal Atresia Research: A Bibliometric Study

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1702223 ◽

2020 ◽

Author(s):

Xiaoyan Feng ◽

Illya Martynov ◽

Anne Suttkus ◽

Martin Lacher ◽

Steffi Mayer

Keyword(s):

Esophageal Atresia ◽

Pediatric Surgery ◽

Perioperative Complications ◽

Citation Rate ◽

Surgical Techniques ◽

Global Network ◽

Term Outcome ◽

Long Term Outcome ◽

The Past

Abstract Introduction Research on esophageal atresia (EA) has been heavily published over the past decades. Herein, we aimed to study the quantity and quality as well as key topics in EA research with regards to global collaborations among countries and authors. Material and Methods Publications on EA from 1945 to 2018 were extracted from the Web of Science core collection database. Productivity (quantity) was assessed by the number of publications. Quality was estimated from the number of citations, citation rate per item and year, h-index, and impact index. Collaborative networks were evaluated using VOSviewer. All measures were analyzed for countries, authors, and journals. The 10 most cited original articles between 1969 and 2018 in 5-year intervals (n = 100) were manually screened to assess the key points of EA research. Results A total of 2,170 publications from 85 countries published in 388 journals were identified yielding 26,755 citations, both significantly increasing over time (p < 0.001). The most productive countries and authors also accounted for high-quality publications and benefited from an active global network. The most productive journals derived from the field of pediatric surgery but accounted only for one-third of EA papers. The best cited journals were unspecific for pediatric surgery. Long-term outcome remained the most important topic in EA research, followed by surgical techniques, epidemiology, associated anomalies, perioperative complications, and postnatal management. In contrast, basic science was underrepresented. Conclusion Over the past seven decades, EA publications increased tremendously. Productiveness and quality benefited from global networking. Long-term outcome remains the key interest of EA research.

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The Long-term Outcome of Esophageal Atresia

Journal of the Korean Association of Pediatric Surgeons ◽

10.13029/jkaps.2008.14.2.117 ◽

2008 ◽

Vol 14 (2) ◽

pp. 117 ◽

Cited By ~ 2

Author(s):

Jae Hong Jeong ◽

Hye Eun Kim ◽

Suk Koo Lee ◽

Jeong Meen Seo

Keyword(s):

Esophageal Atresia ◽

Term Outcome ◽

Long Term Outcome

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DOZ047.74: Long-term outcome of preserving the native esophagus in long-gap esophageal atresia by thoracoscopic traction technique

Diseases of the Esophagus ◽

10.1093/dote/doz047.74 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

S H A J Tytgat ◽

E S van Tuyll van Serooskerken ◽

D C van der Zee ◽

J W Verweij ◽

M Y A Lindeboom

Keyword(s):

Median Time ◽

Esophageal Atresia ◽

Oral Feeding ◽

X Rays ◽

Term Outcome ◽

Long Term Outcome ◽

Long Gap ◽

Anastomotic Strictures ◽

Long Gap Esophageal Atresia

Abstract Background Long-gap esophageal atresia (LGEA) is defined as atresia without distal tracheoesophageal fistula. Preserving the native esophagus is considered superior over intestinal interposition. Thoracoscopic traction technique facilitates lengthening of the esophageal ends, and allows anastomosis within the first weeks of life. The aim of this study was to evaluate the long-term outcome of LGEA patients treated by thoracoscopic traction technique. Methods From 2007 to 2018, 13 consecutive patients with LGEA were treated by thoracoscopic traction technique. During the first operation a bronchoscopy was performed to evaluate the presence of a proximal fistula. Then thoracoscopic traction sutures were placed at both esophageal ends. Initially a gastrostomy was performed. However, nowadays only a gastropexy is performed to prevent the stomach from migrating into the thorax. Approximation of the esophageal ends was evaluated by postoperative X-rays. Thoracoscopic adhesiolysis was performed when necessary. Both ends were anastomosed during the final surgical procedure, usually within a week. Results In 11 patients the anastomosis could be completed by thoracoscopic traction technique. In two patients the elongation procedure failed. In the first patient the sutures tore out. The second patient had an accidental perforation of the proximal pouch by the Replogle tube. Median time on ventilation until after the final anastomosis was 14 days (range 4–34 days). Five patients required chest tube drainage for anastomotic leakage. The median hospitalization time during the first admission was 47 days (range 31–170 days). All patients needed a median of 4 (range 1–16) dilatations for anastomotic stenosis. Ten patients needed a fundoplication within a median time of 8 weeks (range 2–16 weeks) after the esophageal anastomosis. One patient developed an esophago-bronchial fistula. Median weight at age of 2 years was −1.88 SD (range −3.54 – −0.16) and at age of 4 years −1.53 SD (range −2.94–0.66). All patients tolerated full oral feeding. Conclusion LGEA can be treated successfully after elongation by thoracoscopic traction technique. The procedure leads to an earlier anastomosis and shorter initial hospital stay as compared to delayed primary anastomosis. Full oral feeding is possible in all patients. Dilatation for anastomotic strictures and antireflux surgery is necessary in (almost) all patients.

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Delayed primary anastomosis for management of long-gap esophageal atresia: a meta-analysis of complications and long-term outcome

Pediatric Surgery International ◽

10.1007/s00383-012-3142-2 ◽

2012 ◽

Vol 28 (9) ◽

pp. 899-906 ◽

Cited By ~ 43

Author(s):

Florian Friedmacher ◽

Prem Puri

Keyword(s):

Esophageal Atresia ◽

Primary Anastomosis ◽

Meta Analysis ◽

Term Outcome ◽

Long Term Outcome ◽

Long Gap ◽

Long Gap Esophageal Atresia

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Quality of Life after Surgical Treatment for Esophageal Atresia: Long-Term Outcome of 154 Patients

European Journal of Pediatric Surgery ◽

10.1055/s-0036-1597956 ◽

2017 ◽

Vol 27 (05) ◽

pp. 443-448 ◽

Cited By ~ 7

Author(s):

Michael Laschat ◽

Vera Choinitzki ◽

Nadine Zwink ◽

Ekkehart Jenetzky ◽

Oliver Münsterer ◽

...

Keyword(s):

Quality Of Life ◽

Coping Strategies ◽

Esophageal Atresia ◽

Demographic Data ◽

Term Outcome ◽

Long Term Outcome ◽

Anastomotic Strictures ◽

And Coping

Background The short- and long-term surgical results in patients with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) have been described in depth from a physician's perspective. Contrarily, the perception and coping strategies of affected patients and their parents have rarely been reported. The aim of this study was to generate data on this matter. Patients and Methods A total of 154 patients who had operative reconstruction for EA between 1971 and 2012 were evaluated for demographic data, surgical technique, affection of daily life, and coping strategies. Results Gastroesophageal reflux (GER) symptoms were reported in 59% of cases with 33% requiring fundoplication. Regular bougienages of anastomotic strictures were necessary in 68% with 36% requiring repeated dilatations in the first postoperative year. Enteral nutrition via a nasogastric tube was performed in 66% after surgery. In 40%, the tube was needed until their sixth week of life. In 25%, nutritional support was necessary more than 1 year out of surgery. Quality of life in general was felt to be impaired according to the patients' parents in 50%. Regarding medical advice about long-term morbidities, more than 50% of the parents felt insufficiently advised. There were no statistical differences between the EA/TEF subtypes regarding GER symptoms, frequency of esophageal dilatations, eating behaviors, or support of the parents in feeding management. Conclusion Our observations indicate that a high percentage of EA/TEF patients and families require more intensive aftercare and support during the first year following primary reconstruction than previously thought. We observed a higher need for adequate parental information on long-term complications of their children compared with current practice.

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