Stricture classification of pediatric esophageal strictures (SCOPES): A novel tool to predict response to endoscopic...

Esophageal anastomotic stricture is a common complication following esophageal atresia (EA) repair. While multiple endoscopic therapies exist, predicting individual stricture response remains challenging. Existing classification systems focus primarily on luminal diameter and do not account for complex physical characteristics of the stricture. We developed and evaluated a novel endoscopic scoring tool, stricture classification of pediatric esophageal strictures (SCOPES), to determine if physical features are predictive of treatment response. In addition to its predictive utility, SCOPES aims to standardize the description of and improve communication of stricture morphology across providers and institutions.

A retrospective cohort study was conducted on EA patients treated at a tertiary referral center between 2019 and 2024. Patients with ≥2 endoscopies and documented SCOPES scores were included. The SCOPES tool categorizes strictures based on diameter, length, scar band intrusion, symmetry, and presence of diverticula. Multivariable mixed-effects regression models were used to analyze associations between SCOPES characteristics and the primary outcome of number of therapeutic endoscopies within 6 months.

Seventy patients (238 endoscopies) met inclusion criteria. In multivariable analysis, symmetric strictures and those with highly intrusive scar bands were significantly associated with a greater number of therapeutic endoscopies within 6 months. Two complications were observed, both managed without long-term sequelae.

The SCOPES classification tool identifies physical stricture features that significantly influence response to endoscopic therapy. Circumferential symmetry and scar tissue protuberance were associated with higher treatment burden, suggesting these characteristics may guide therapeutic decision-making. SCOPES may aid in individualizing endoscopic management of pediatric esophageal strictures and warrants prospective validation.