Anastomotic Stricture Definition After Esophageal Atresia Repair: Role of Endoscopic Stricture Index

Abstract

Background: To evaluate the feasibility and efficacy of endoscopic stricture index (SI_EN) to define anastomotic strictures (ASs) and to predict the need of dilatations.

Materials and methods: A retrospective longitudinal study was conducted on patients who underwent esophageal atresia repair from 1998-2020 (ethical committee approval CHPED-05-20-AS). SI_EN was calculated on the first endoscopy performed as follows: (D - d)/D, where D is the maximum diameter of lumen of the upper esophagus close to the AS and d is the diameter of lumen of the stricture. Nonparametric variables were examined using Wilcoxon-Mann-Whitney test, and continuous variables were analyzed using Spearman's test and regression analysis. A P value <0.05 was considered statistically significant. The sensitivity, specificity, and positive and negative predictive values of SI_EN were also calculated, and a receiver operating characteristic curve was designed.

Results: A total of 46 patients were included in the study. A statistically significant correlation was found between SI_EN and number of dilations (Spearman's correlation rate, 0.7; P < 0.0005). A SI_EN threshold value ≥0.6 showed sensitivity of 100%, specificity of 80%, positive predictive value of 54%, negative predictive value of 100%, and the area under the curve of 84%.

Conclusions: SI_EN seems to be a good AS definer and prognostic tool; our study suggests that an AS could be defined by a SI_EN ≥0.6.

Keywords: Anastomotic strictures; Esophageal atresia; Esophageal endoscopic dilatations; Stricture index.