Related Experiment Video
Updated: Jul 30, 2025
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Assessing the Feasibility of Predicting Intermediate Outcomes of Esophageal Atresia Using Okamoto Classification: A
Santosh Dey1, V Shankar Raman2, Sandeep Agarwala3
1Department of Pediatric Surgery, Army Hospital (Research and Referral), New Delhi, India.
Insights
The Okamoto classification effectively predicts long-term outcomes for esophageal atresia patients. Higher risk groups (Okamoto IV) experienced significantly greater mortality and morbidity one year post-discharge.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Clinical Prognostication
Background:
- Existing risk classifications for esophageal atresia focus on immediate survival.
- These classifications often neglect long-term morbidity and mortality.
- A comprehensive understanding of long-term outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the impact of Okamoto's classification on 1-year post-discharge mortality and morbidity in operated esophageal atresia cases.
- To assess the efficacy of Okamoto's classification in predicting long-term survival and complications.
- To bridge the knowledge gap regarding long-term outcomes in esophageal atresia surgery.
Main Methods:
- Prospective study of 106 children operated for esophageal atresia-tracheoesophageal fistula (2012-2015).
- Children were classified using Okamoto's system.
- Follow-up for 1 year post-discharge to record mortality and complication rates.
Main Results:
- Of 69 eligible children, 21 (30%) died during follow-up.
- Mortality was highest in Okamoto Class IV (75%) and lowest in Class I (17.5%) (P=0.003).
- Significant correlations found between higher Okamoto classes (III and IV) and increased rates of poor weight gain, lower respiratory tract infections, and failure to thrive.
Conclusions:
- Okamoto's prognostic classification remains relevant at 1-year follow-up.
- The classification accurately predicts increased mortality and morbidity in higher-risk groups (Okamoto Class IV).
- This highlights the importance of preoperative risk stratification for long-term patient outcomes.
Purpose:
Several risk classifications based on various preoperative factors have been proposed to prognosticate the immediate survival of children operated for esophageal atresia. A major drawback of these classifications is that they only focus on immediate survival while ignoring the long-term morbidity and mortality in these children. Our study aims to bridge this gap in knowledge by studying the impact of one such classification (Okamoto's classification) on mortality and morbidity during a period of 1 year after discharge from the hospital in operated cases of esophageal atresia.
Materials And Methods:
After institutes ethical clearance, 106 children operated for esophageal atresia-tracheoesophageal fistula between 2012 and 2015 were studied prospectively for a period of 1 year after their discharge. The children were graded as per Okamoto classification. The primary objective was to determine the efficacy of this classification in predicting the survival rates in infancy and the secondary objective was to compare the complication rates in these children based on the classification.
Results:
Sixty-nine children met the inclusion criteria. There were 40, 15, 10, and 4 children in Okamoto Classes I, II, III, and IV, respectively. Twenty-one patients (30%) died during the follow-up period with the maximum number of deaths occurring in Okamoto Class IV (75%) and the minimum in Okamoto Class I (17.5%) (P = 0.003). There was a significant correlation between the Okamoto classes with the incidence of poor weight gain (P = 0.001), lower respiratory tract infection (P = 0.007), and failure to thrive (P = 0.01) higher in Okamoto IV and III as compared to I and II.
Conclusion:
Okamoto prognostic classification during the initial hospitalization is relevant even at 1 year follow-up with increased mortality and morbidity in Okamoto Class IV as compared to Class I.
Related Concept Videos
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:21Barrett Esophagus-I: Introduction
This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more...
01:21Barrett Esophagus-II: Clinical Manifestations and Management
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...