The burden of esophageal dilatations following repair of esophageal atresia

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dc.contributor.authorCampos, J.
dc.contributor.authorTan Tanny, S.P.
dc.contributor.authorKuyruk, S.
dc.contributor.authorSekaran, P.
dc.contributor.authorHawley, A.
dc.contributor.authorBrooks, J.A.
dc.contributor.authorBekhit, E.
dc.contributor.authorHutson, J.M.
dc.contributor.authorCrameri, J.
dc.contributor.authorMcLeod, E.
dc.contributor.authorTeague, W.J.
dc.contributor.authorKing, S.K.
dc.date.issued2020
dc.description.abstractAim: To describe the burden of esophageal dilatations in patients following esophageal atresia (EA) repair. Method: A retrospective review was performed at The Royal Children's Hospital, Melbourne, of all neonates undergoing operative repair for EA over a 17-year period (1999-2015). Stricture was defined by radiological and/or intra-operative findings of narrowing at the esophageal anastomosis. Data recorded included EA type, perinatal details, operative approach, esophageal anastomosis outcome, dilatation requirement, and survival. Key endpoints were anastomotic leakage and tension, esophageal dilatation technique, dilatation frequency, fundoplication, and complications. Results: During the study period, 287 newborn EA patients were admitted, of which 258 underwent operative repair and survived to primary discharge. Excluding 11 patients with isolated tracheoesophageal fistula, 247 patients were included in the final analysis. Intra-operative anastomotic tension was documented in 41/247 (16.6%), anastomotic leak occurred in 48/247 (19.4%), and fundoplication was performed in 37/247 (15.0%). Dilatations were performed in 149/247 (60.3%). Techniques included bougie-alone (92/149, 61.7%), combination of bougie and balloon (51/149, 34.2%), and balloon-alone (6/149, 4.0%). These patients underwent 1128 dilatations; median number of dilatations per patient was 4 (interquartile range 2-8). Long-gap EA and anastomotic tension were risk factors (p < 0.01) for multiple dilatations. Complications occurred in 13/1128 (1.2%) dilatation episodes: 11/13 esophageal perforation, 2/13 clinically significant aspiration. Perforations were rare events in both balloon (6/287, 2.1%) and bougie dilatations (4/841, 0.5%); one patient had a perforation from guidewire insertion. Conclusions: Esophageal dilatation occurred in a majority of EA patients. Long-gap EA was associated with an increased burden of esophageal dilatation. Perforations were rare events in balloon and bougie dilatations. Type of Study: Original article - retrospective review. Level of Evidence: II.
dc.description.statementofresponsibilityJose Campos, Sharman P. Tan Tanny, Sema Kuyruk, Prabhu Sekaran, Alisa Hawley, Jo-Anne Brooks, Elhamy Bekhit, John M. Hutson, Joseph Crameri, Elizabeth McLeod, Warwick J. Teague, Sebastian K. King
dc.identifier.citationJournal of Pediatric Surgery, 2020; 55(11):2329-2334
dc.identifier.doi10.1016/j.jpedsurg.2020.02.018
dc.identifier.issn0022-3468
dc.identifier.issn1531-5037
dc.identifier.orcidTeague, W.J. [0000-0003-4747-6025]
dc.identifier.urihttp://hdl.handle.net/2440/131580
dc.language.isoen
dc.publisherElesvier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT1168142
dc.rightsCrown Copyright © 2020 Published by Elsevier Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.jpedsurg.2020.02.018
dc.subjectEsophageal atresia; stricture; dysmotility; dilatation; anastomosis
dc.titleThe burden of esophageal dilatations following repair of esophageal atresia
dc.typeJournal article
pubs.publication-statusPublished

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