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Anastomotic stricture indexes for endoscopic balloon dilation after esophageal atresia repair: a single-center study

Jinshi Huang1, Junmin Liao2, Shen Yang2

  • 1Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang, China.

Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus
|September 18, 2020
PubMed

Insights

Endoscopic balloon dilatation improved stricture indexes in children after esophageal atresia repair. The number of dilatations and upper pouch stricture index at 6 months predict success, aiding treatment decisions.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Medical Engineering

Background:

  • Anastomotic stricture is a common complication following esophageal atresia (EA) repair in children.
  • Endoscopic balloon dilatation is a primary treatment modality for these strictures.
  • Predicting the success of dilatation is crucial for optimizing patient management and outcomes.

Purpose of the Study:

  • To evaluate changes in anastomotic stricture indexes (SIs) and stricture diameter (SD) after endoscopic balloon dilatation in children with post-EA repair strictures.
  • To identify predictors of medium-term success (at least 3 months) following dilatation.
  • To assess the accuracy of identified predictors in forecasting dilatation success.

Main Methods:

  • Retrospective review of 60 pediatric patients who underwent endoscopic balloon dilatation for post-EA repair anastomotic stricture.
  • Analysis of stricture indexes (SD, U-SI, L-SI, U-EASI, L-EASI) before and 6 months after the first dilatation.
  • Univariate, multivariate logistic regression, and receiver operator characteristic (ROC) curve analyses to identify predictors of medium-term dilatation success.

Main Results:

  • Significant improvements were observed in SD and all measured SIs 6 months after the first dilatation compared to baseline.
  • Logistic regression identified the number of dilatations and the upper pouch stricture index (U-SI) at 6 months as significant predictors of medium-term success.
  • A combined model using U-SI (cut-off 55.6%) and dilatation number (cut-off 10) demonstrated high accuracy (AUC-ROC: 0.95) in predicting success.

Conclusions:

  • Endoscopic balloon dilatation is effective in improving anastomotic stricture parameters in children post-EA repair.
  • The number of dilatations and the 6-month U-SI are valuable indicators for predicting medium-term dilatation success.
  • These predictors can assist clinicians in determining the need for further dilatations, optimizing treatment strategies.

Keywords:
childrendilatationesophageal atresiastricturestricture index (SI)

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