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Outcome of long gap esophageal atresia at 6 years: A prospective case control cohort study
Agate Bourg1, Frédéric Gottrand2, Benoit Parmentier1
1Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France.
Insights
Long gap esophageal atresia (EA) leads to more complications and longer hospital stays in children. Digestive issues persist at age 6, highlighting the challenges of treating this condition.
Area of Science:
- Pediatric Surgery
- Congenital Malformations
- Gastroenterology
Background:
- Esophageal atresia (EA) is the most common esophageal malformation.
- Long gap EA presents significant therapeutic challenges for pediatric surgeons.
- Understanding outcomes is crucial for managing this condition.
Purpose of the Study:
- To compare outcomes of long gap EA versus non-long gap EA/tracheo-esophageal fistula (TEF).
- To assess the impact of initial treatment on mortality and morbidity.
- To evaluate outcomes at 1 and 6 years post-surgery.
Main Methods:
- A multicentric, population-based, prospective study in France (2008-2010).
- Compared 31 long gap EA patients with 62 non-long gap EA/TEF patients.
- Assessed morbidity at birth, 1 year, and 6 years.
Main Results:
- Long gap EA patients experienced longer parenteral nutrition, hospital stays, and higher complication rates by age 1.
- Digestive complications were more frequent in long gap EA at 6 years.
- Tracheomalacia and spine deformation differed between groups; no significant difference in mortality or overall morbidity between treatment types.
Conclusions:
- Long gap EA significantly impacts digestive morbidity up to age 6.
- Initial treatment choice did not significantly affect long-term outcomes, except for feeding difficulties.
Background Data:
EA is the most frequent congenital esophageal malformation. Long gap EA remains a therapeutic challenge for pediatric surgeons. A case case-control prospective study from a multi-institutional national French data base was performed to assess the outcome, at age of 1 and 6 years, of long gap esophageal atresia (EA) compared with non-long gap EA/tracheo-esophageal fistula (TEF). The secondary aim was to assess whether initial treatment (delayed primary anastomosis of native esophagus vs. esophageal replacement) influenced mortality and morbidity at ages 1 and 6 years.
Methods:
A multicentric population-based prospective study was performed and included all patients who underwent EA surgery in France from January 1, 2008 to December 31, 2010. A comparative study was performed with non-long gap EA/TEF patients. Morbidity at birth, 1 year, and 6 years was assessed.
Results:
Thirty-one patients with long gap EA were compared with 62 non-long gap EA/TEF patients. At age 1 year, the long gap EA group had longer parenteral nutrition support and longer hospital stay and were significantly more likely to have complications both early post-operatively and before age 1 year compared with the non-long gap EA/TEF group. At 6 years, digestive complications were more frequent in long gap compared to non-long gap EA/TEF patients. Tracheomalacia was the only respiratory complication that differed between the groups. Spine deformation was less frequent in the long gap group. There were no differences between conservative and replacement groups at ages 1 and 6 years except feeding difficulties that were more common in the native esophagus group.
Conclusions:
Long gap strongly influenced digestive morbidity at age 6 years.
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