Clinical Variables as Indicative Factors for Endoscopy in Adolescents with Esophageal Atresia

Audun Mikkelsen; Unn Inger Møinichen; Henrik Mikael Reims; Krzysztof Grzyb; Lars Aabakken; Lars Mørkrid; Hanneke IJsselstijn; Ragnhild Emblem

doi:10.1016/j.jpedsurg.2022.10.003

Clinical Variables as Indicative Factors for Endoscopy in Adolescents with Esophageal Atresia

J Pediatr Surg. 2023 Aug;58(8):1421-1429. doi: 10.1016/j.jpedsurg.2022.10.003. Epub 2022 Oct 19.

Authors

Audun Mikkelsen¹, Unn Inger Møinichen², Henrik Mikael Reims³, Krzysztof Grzyb³, Lars Aabakken⁴, Lars Mørkrid⁵, Hanneke IJsselstijn⁶, Ragnhild Emblem⁷

Affiliations

¹ Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: uxmiau@ous-hf.no.
² Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Norway.
³ Department of Pathology, Oslo University Hospital, Oslo, Norway.
⁴ Department of Transplantation medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ Department of Medical biochemistry, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁶ Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
⁷ Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

PMID: 36344284
DOI: 10.1016/j.jpedsurg.2022.10.003

Abstract

Introduction: Gastro-esophageal reflux disease (GERD) occurs frequently in patients operated for esophageal atresia (EA). Longstanding esophagitis may lead to dysphagia, strictures, columnar metaplasia, and dysplasia with an increased risk of adenocarcinoma. Are clinical factors and non-invasive assessments reliable indicators for follow-up with endoscopy?

Material and method: A follow-up study with inclusion of EA adolescents in Norway born between 1996 and 2002 was conducted. Clinical assessment with pH monitoring, endoscopy with biopsies, along with interviews and questionnaires regarding gastroesophageal reflux disease (GERD) and dysphagia were performed.

Results: We examined 68 EA adolescents. 62% reported GERD by interview, 22% by questionnaire. 85% reported dysphagia by interview, 71% by questionnaire. 24-hour pH monitoring detected pathological reflux index (RI) (>7%) in 7/59 (12%). By endoscopy with biopsy 62 (92%) had histologic esophagitis, of whom 3 (4%) had severe esophagitis. Gastric metaplasia was diagnosed in twelve (18%) adolescents, intestinal metaplasia in only one (1.5%). None had dysplasia or carcinoma. Dysphagia and GERD were statistically correlated to esophagitis and metaplasia, but none of the questionnaires or interviews alone were good screening instruments with high combined sensitivity and specificity. A compound variable made by simply taking the mean of rescaled RI and dysphagia by interview showed to be the best predictor of metaplasia (85% sensitivity, 67% specificity).

Conclusion: The questionnaires and interviews used in the present study were not good screening instruments alone. However, combining dysphagia score by interview and RI may be helpful in assessing which patients need endoscopy with biopsy at each individual follow-up examination.

Level of evidence: Level II prognostic study.

Keywords: Columnar metaplasia; Dysphagia; Endoscopy; Esophageal atresia; Gastroesophageal reflux; Metaplasia; ROC-curve.

MeSH terms

Adolescent
Deglutition Disorders* / etiology
Endoscopy, Gastrointestinal
Esophageal Atresia* / complications
Esophageal Atresia* / diagnosis
Esophageal Atresia* / surgery
Esophagitis* / complications
Follow-Up Studies
Gastroesophageal Reflux* / diagnosis
Gastroesophageal Reflux* / etiology
Humans
Metaplasia / complications