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Classification of Esophageal Strictures following Esophageal Atresia Repair
Francesco Macchini1, Giovanni Parente1, Anna Morandi1
1Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.
Insights
The endoscopic stricture index (SI_END) effectively predicts the need for dilations in patients with anastomotic strictures (AS) after esophageal atresia (EA) repair. This index is more reliable than clinical factors for anticipating AS development and dilation requirements.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Anastomotic strictures (AS) are a common complication following esophageal atresia (EA) repair.
- Stratifying AS severity and predicting the need for interventions are crucial for patient management.
Purpose of the Study:
- To stratify anastomotic strictures (AS) in patients who underwent esophageal atresia (EA) repair.
- To identify predictors for the requirement of endoscopic dilations.
Main Methods:
- Retrospective analysis of pediatric patients operated on for EA between 2004 and 2014.
- Measurement of stricture index (SI) using both radiological (SI_XR) and endoscopic (SI_END) methods.
- Correlation analysis between SI measurements and the number of dilations using Spearman's test and linear regression.
Main Results:
- 40 patients were included, with Gross's type C EA being the most common (87.5%).
- Endoscopic SI (SI_END) showed a significant correlation with the number of dilations needed, unlike radiological SI (SI_XR).
- Specific SI_END ranges predicted the need for zero, one, or multiple dilations, with clinical variables showing low predictive value.
Conclusions:
- The endoscopic stricture index (SI_END) is a valuable tool for classifying AS and predicting the need for endoscopic dilations.
- SI_END offers superior predictive value compared to clinical characteristics for AS development and subsequent dilation requirements.
Introduction:
The aim of this study was to stratify anastomotic strictures (AS) following esophageal atresia (EA) repair and to establish predictors for the need of dilations.
Materials And Methods:
A retrospective study on children operated on for EA between 2004 and 2014 was conducted. The stricture index (SI) was measured both radiologically (SIXR) and endoscopically (SIEND). A correlation analysis between the SI and the number of dilations was performed using Spearman's test and linear regression analysis.
Results:
In this study, 40 patients were included: 35 (87.5%) presented with Gross's type C EA, 3 (7.5%) type A, 1 (2.5%) type B, and 1 (2.5%) type D. The mean follow-up time was 101 ± 71.1 months (range: 7.8-232.5, median: 97.6). The mean SIXR was 0.56 ± 0.16 (range: 0.15-0.86). The mean SIEND was 0.45 ± 0.22 (range: 0.15-0.85). Twenty-four patients (60%) underwent a mean of 2 endoscopic dilations (range: 1-9). The number of dilations was poorly correlated with SIXR, while significantly correlated with SIEND. Patients who did not need dilations had a SIEND < 0.33, patients who needed only one dilation had 0.33 ≤ SIEND < 0.44, and those with SIEND ≥ 0.44 needed two or more dilations. No significant association with other clinical variables was found. All patients were asymptomatic at the time of the first endoscopy.
Conclusion:
SIEND is a useful tool to classify AS and can represent a predictor of the need for endoscopic dilation. The role of the SIEND becomes even more important as clinical characteristics have a low predictive value for the development of an AS and the need for subsequent endoscopic esophageal dilatations.
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