Long-Term Effectiveness of Antireflux Surgery in Esophageal Atresia Patients

Jönsson, Linus; Dellenmark‐Blom, Michaela; Enoksson, Oskar; Friberg, Lars Göran; Gatzinsky, Vladimir; Sandin, Anders; Abrahamsson, Kate

doi:10.1055/s-0039-1681023

Cited by 7 publications

(3 citation statements)

References 35 publications

(50 reference statements)

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“…In line with our results, others have shown that a significant proportion of EA patients experience symptom recurrence post-fundoplication. 16 , 17 , 21 , 22 A retrospective study showed similar redo-rates to our study, in patients with and without EA (13% vs. 8%). 23 In that study, however, recurrent symptoms or complications post-surgery were not compared and assessed in both groups, and controls were not age-matched.…”

Section: Discussionsupporting

confidence: 87%

Fundoplication in children with esophageal atresia: preoperative workup and outcome

Lennep

Chung

Jiwane

et al. 2022

Diseases of the Esophagus

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Summary Up to 45% of esophageal atresia (EA) patients undergo fundoplication during childhood. Their esophageal dysmotility may predispose to worse fundoplication outcomes compared with patients without EA. We therefore compared fundoplication outcomes and symptoms pre- and post-fundoplication in EA patients with matched patients without EA. A retrospective review of patients with- and without EA who underwent a fundoplication was performed between 2006 and 2017. Therapeutic success was defined as complete sustained resolution of symptoms that were the reason to perform fundoplication. Fundoplication indications of 39 EA patients (49% male; median age 1.1 [0.1–17.0] yrs) and 39 non-EA patients (46% male; median age 1.3 [0.3–17.0] yrs) included respiratory symptoms, brief resolved unexplained events, typical symptoms of gastroesophageal reflux disease, recurrent strictures and respiratory problems. Post-fundoplication, therapeutic success was achieved in 5 (13%) EA patients versus 29 (74%) non-EA patients (P<0.001). Despite therapeutic success, all 5 (13%) EA patients developed postoperative sustained symptoms/complications versus 12 (31%) non-EA patients. Eleven (28%) EA patients versus 3 (8%) non-EA patients did not achieve any therapeutic success (P=0.036). Remaining patients achieved partial therapeutic success. EA patients suffered significantly more often from postoperative sustained dysphagia (41% vs. 13%; P=0.039), gagging (33% vs. 23%; P<0.001) and bloating (40% vs. 17%; P=0.022). Fundoplication outcomes in EA patients are poor and EA patients are more susceptible to post-fundoplication sustained symptoms and complications compared with patients without EA. The decision to perform fundoplication in EA patients with proven gastroesophageal reflux disease needs to be made with caution after thorough multidisciplinary evaluation.

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Section: Discussionsupporting

confidence: 87%

Fundoplication in children with esophageal atresia: preoperative workup and outcome

Lennep

Chung

Jiwane

et al. 2022

Diseases of the Esophagus

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“…In children aged 2-7 with DREA, the least reported symptom was heartburn and antire ux medication was commonly used. Antire ux surgery however, was rarely employed in children aged 2-7, which is in line with recent studies suggesting restrictiveness [49]. In children aged 8-18 with DREA, the least reported symptom was vomiting, but the use of antire ux treatment may serve as explanation.…”

Section: Discussionsupporting

confidence: 76%

Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

Dellenmark‐Blom

Öst

et al. 2022

Preprint

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Background In 10-15% of children with esophageal atresia (EA) delayed reconstruction of esophageal atresia (DREA) is necessary due to long-gap EA and/or prematurity/low birth weight. They represent a patient subgroup with high risk of complications. We aimed to evaluate postoperative morbidity and health-related quality of life (HRQOL) in a Swedish national cohort of children with DREA. Methods Postoperative morbidity, age-specific generic HRQOL (PedsQLTM 4.0) and condition-specific HRQOL (The EA-QOL questionnaires) in children with DREA were compared with children with EA who had primary anastomosis (PA). Factors associated with the DREA group’s HRQOL scores were analyzed using Mann-Whitney U-test and Spearman’s rho. Clinical data was extracted from the medical records. Significance level was p<0.05.Results Thirty-four out of 45 families of children with DREA were included and 30 returned the questionnaires(n=8 children aged 2-7 years; n=22 children aged 8-18 years). Compared to children with PA(42 children aged 2-7 years; 64 children aged 8-18 years), there were no significant differences in most early postoperative complications. At follow-up, symptom prevalence in children aged 2-7 with DREA ranged from 37.5% (heartburn) to 75%(cough). Further digestive and respiratory symptoms were present in ≥50%. In children aged 8-18, it ranged from 14.3%(vomiting) to 40.9%(cough), with other digestive and airway symptoms present in 19.0-27.3%. Except for chest tightness(2-7 years), there were no significant differences in symptom prevalence between children with DREA and PA, nor between their generic or condition-specific HRQOL scores(p>0.05). More children with DREA underwent esophageal dilatations (both age groups), gastrostomy feeding(2-7 years), and antireflux treatment (8-18 years), p<0.05. Days to hospital discharge after EA repair and a number of associated anomalies showed a strong negative correlation with HRQOL scores (2-7 years). Presence of cough, airway infection, swallowing difficulties and heartburn were associated with lower HRQOL scores (8-18 years), p<0.05. Conclusions Although children with DREA need more treatments, they are not a risk group for postoperative morbidity and impaired HRQOL compared with children with PA. However, those with a long initial hospital stay, several associated anomalies and digestive or respiratory symptoms risk worse HRQOL. This is important information for clinical practice, families and patient stakeholders.

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“…In children aged 2–7 with DREA, the least reported symptom was heartburn and antireflux medication was commonly used. Antireflux surgery however, was rarely employed in children aged 2–7, which is in line with recent studies suggesting restrictiveness [ 50 ]. Furthermore, none of the four children who were reported vomiting showed esophagitis according to biopsies.…”

Section: Discussionsupporting

confidence: 70%

Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

Dellenmark‐Blom

Öst

et al. 2022

Orphanet J Rare Dis

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Background In 10–15% of children with esophageal atresia (EA) delayed reconstruction of esophageal atresia (DREA) is necessary due to long-gap EA and/or prematurity/low birth weight. They represent a patient subgroup with high risk of complications. We aimed to evaluate postoperative morbidity and health-related quality of life (HRQOL) in a Swedish national cohort of children with DREA. Methods Postoperative morbidity, age-specific generic HRQOL (PedsQL™ 4.0) and condition-specific HRQOL (The EA-QOL questionnaires) in children with DREA were compared with children with EA who had primary anastomosis (PA). Factors associated with the DREA group’s HRQOL scores were analyzed using Mann–Whitney U-test and Spearman’s rho. Clinical data was extracted from the medical records. Significance level was p < 0.05. Results Thirty-four out of 45 families of children with DREA were included and 30 returned the questionnaires(n = 8 children aged 2–7 years; n = 22 children aged 8–18 years). Compared to children with PA(42 children aged 2–7 years; 64 children aged 8–18 years), there were no significant differences in most early postoperative complications. At follow-up, symptom prevalence in children aged 2–7 with DREA ranged from 37.5% (heartburn) to 75% (cough). Further digestive and respiratory symptoms were present in ≥ 50%. In children aged 8–18, it ranged from 14.3% (vomiting) to 40.9% (cough), with other digestive and airway symptoms present in 19.0–27.3%. Except for chest tightness (2–7 years), there were no significant differences in symptom prevalence between children with DREA and PA, nor between their generic or condition-specific HRQOL scores (p > 0.05). More children with DREA underwent esophageal dilatations (both age groups), gastrostomy feeding (2–7 years), and antireflux treatment (8–18 years), p < 0.05. Days to hospital discharge after EA repair and a number of associated anomalies showed a strong negative correlation with HRQOL scores (2–7 years). Presence of cough, airway infection, swallowing difficulties and heartburn were associated with lower HRQOL scores (8–18 years), p < 0.05. Conclusions Although children with DREA need more treatments, they are not a risk group for postoperative morbidity and impaired HRQOL compared with children with PA. However, those with a long initial hospital stay, several associated anomalies and digestive or respiratory symptoms risk worse HRQOL. This is important information for clinical practice, families and patient stakeholders.

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Long-Term Effectiveness of Antireflux Surgery in Esophageal Atresia Patients

Cited by 7 publications

References 35 publications

Fundoplication in children with esophageal atresia: preoperative workup and outcome

Fundoplication in children with esophageal atresia: preoperative workup and outcome

Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

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