Risk factors and management for anastomotic stricture after surgical reconstruction of esophageal atresia

Che-Ming Chiang; Wen-Ming Hsu; Mei-Hwei Chang; Hong-Yuan Hsu; Yen-Hsuan Ni; Huey-Ling Chen; Jia-Feng Wu

doi:10.1016/j.jfma.2020.06.020

Risk factors and management for anastomotic stricture after surgical reconstruction of esophageal atresia

J Formos Med Assoc. 2021 Jan;120(1 Pt 2):404-410. doi: 10.1016/j.jfma.2020.06.020. Epub 2020 Jun 22.

Authors

Che-Ming Chiang¹, Wen-Ming Hsu², Mei-Hwei Chang³, Hong-Yuan Hsu³, Yen-Hsuan Ni³, Huey-Ling Chen³, Jia-Feng Wu⁴

Affiliations

¹ Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
² Pediatric Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan. Electronic address: billwmshu@gmail.com.
³ Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
⁴ Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan. Electronic address: wjf@ntu.edu.tw.

PMID: 32586720
DOI: 10.1016/j.jfma.2020.06.020

Abstract

Background/purpose: Anastomotic stricture (AS) is a major morbidity of patients with esophageal atresia (EA) after surgical reconstruction. Our study determined the risk factors of AS after EA reconstruction. The therapeutic efficacy and complications of esophageal dilatation for children with AS were also evaluated.

Methods: Forty children treated for EA between January 2008 and December 2018 were included in this retrospective analysis. Esophageal dilatation was performed when AS was diagnosed. The therapeutic effect of esophageal dilatation was determined based on nutritional status, as assessed by the weight-for-age z-score.

Results: Sixteen EA patients developed AS. A gap >1.5 cm between the esophageal pouches (P = 0.02) in patients with EA and type A EA was a risk factor for developing AS. A mean of 7.7 sessions of esophageal dilatation were performed per patient, and no complications occurred. The nutritional status of EA children with AS after dilatation was not inferior to that of the children without AS at the 6-month follow-up.

Conclusion: A gap >1.5 cm between the esophageal pouches and type A EA are risk factors for AS after esophageal reconstruction. Esophageal dilatation is both safe and effective for managing strictures and improves nutritional status in EA children with AS.

Keywords: Anastomotic stricture; Esophageal atresia; Esophageal dilatation; Nutritional status.

MeSH terms

Anastomosis, Surgical / adverse effects
Constriction, Pathologic / etiology
Esophageal Atresia* / surgery
Esophageal Stenosis* / etiology
Esophageal Stenosis* / surgery
Humans
Postoperative Complications / epidemiology
Postoperative Complications / therapy
Retrospective Studies
Risk Factors
Treatment Outcome