Outcome of patients operated on for esophageal atresia: 30 years' experience

The aim of this study was to evaluate the outcome and late sequelae of patients with esophageal atresia or tracheoesophageal fistula.

Sixty patients with esophageal atresia or tracheoesophageal fistula (EA-TEF) were treated in Tampere University Hospital in the years 1963 through 1993. Long-term outcome was evaluated with a questionnaire, pulmonary and esophageal function test results, 24-hour pH level monitoring, tracheobronchoscopy findings, and esophagogastroscopy with biopsy sections and samples for bacterial cultures.

One third of the respondents reported having impaired quality of life because of respiratory infections, dyspnea, and difficulties in swallowing and coughing at night. Eighteen percent had gastroesophageal reflux (GER) symptoms. The rate of symptoms decreased with age. Impaired pulmonary function, GER, abnormal esophageal peristalsis, and transit time were registered. Tracheobronchoscopy showed tracheal narrowing and inflammation in one third; in histopathologic analysis, however, the rate of inflammation was more than doubled. Histologically, esophageal inflammation was found in 51%, Barrett's esophagus in 6%, and a Helicobacter pylori infection in 21% of cases. The severity of GER, esophageal peristaltic abnormality, tracheal inflammation, and impairment of pulmonary function seems to be alleviated with age.

Although the long-term outcome of EA-TEF patients seems to be favorable, respiratory and gastrointestinal symptoms as well as functional abnormalities remain frequent. Gastric metaplasia in the esophagus and the high rate of tracheal, esophageal, and gastric inflammation indicate a need for long-term follow-up.